Advanced Electronic Instrumentation for Electrical Impedance Myography

ABSTRACT

Embodiments of devices and methods for evaluating tissue are disclosed. In one embodiment, a method for measuring a characteristic of a tissue may include passing a current through the tissue, measuring a signal corresponding to the voltage resulting from passing the current through the tissue, analyzing current passed through the tissue and resulting voltage to determine the electrical characteristics of the tissue; and analyzing the electrical characteristics of the tissue to determine a status of the tissue. Disposable sensors are disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of application Ser. No. 15/864,531filed Jan. 8, 2018. application Ser. No. 15/864,531 (US PatentPublication 20180177427) is a continuation application of U.S. patentapplication Ser. No. 14/826,134 filed Aug. 13, 2015 (US PatentApplication Publication 20160038053) now U.S. Pat. No. 9,861,293.Application Ser. No. 14/826,134 is a divisional application of U.S.patent application Ser. No. 13/842,698 filed Mar. 15, 2013, (US PatentApplication publication 20130338473), now U.S. Pat. No. 9,113,808,application Ser. No. 13,842,698 is a continuation-in-part application ofU.S. patent application Ser. No. 13/832,659, filed Mar. 14, 2013, (USPatent Application publication 20140039341), now U.S. Pat. No.8,892,198, which is an entry into the U.S. National stage of, and claimspriority to, International Application Number PCT/US2012/035658(Publication WO2012/149471) filed Apr. 27, 2012, which is entitled tothe benefits of priority under 35 U.S.C. §§ 119-120 to U.S. ProvisionalPatent Application Nos. 61/480,127 and 61/570,298 filed on Apr. 28,2011, and Dec. 13, 2011, respectively. The entireties of all of theseapplications and patents are incorporated herein by reference.

Application Ser. No. 13,842,698 also claims priority to and incorporatesin its entirety by reference U.S. Provisional Patent Application No.61/775,620 titled “EIM Technology,” filed Mar. 10, 2013. The entirety ofthis application is incorporated herein by reference.

GOVERNMENT LICENSE RIGHTS

This invention was made with U.S. government support under grantR43NS070385-01 awarded by National Institutes of Health and grant1046826 awarded by the National Science Foundation. The government hascertain rights in the invention.

FIELD OF THE INVENTION

Embodiments of the present disclosure relate generally to medicaldevices suitable for evaluating the health and/or status of bodilytissues. In particular, some embodiments of the present disclosurerelate to devices and methods for evaluating the health and/or statusof, e.g., muscular tissues for the purposes of evaluating the efficacyof one or more treatment regimens.

BACKGROUND OF THE INVENTION

Embodiments of this disclosure will describe devices and methods forconducting measurements to determine status and/or health of tissue. Onearea of the disclosure will address neuromuscular diseases, which arevery common. In 2009, there were over 18 million outpatient physicianencounters with patients diagnosed with a range of neuromusculardiseases, from ALS to myoneural disorders like myasthenia gravis. Theseepisodes generated nearly $7B in physician charges and can only beexpected to grow as the episode volume is expected to reach over 20million by 2014 (+8.25%).

Another area our disclosure will address common medical complaints, suchas, e.g., lower back and neck pain. These common medical complaints aresometimes the primary causes of disability, lost productivity, andmedical costs. For example, 60-80% of adults experience at least onesignificant episode of back pain in their lifetime. In a single year,about 15% will have debilitating back pain, and a substantial proportionwill seek medical attention. Lower back pain has been estimated as thefifth or higher leading cause of all medical visits, and the first orsecond leading cause for patients seeking evaluation and treatment of acondition. Stated another way, about 4-5% of all medical encounters arerelated to back pain. In two major health surveys (National HealthInterview Survey and National Health and Nutrition Survey), from2004-2008, 28-40% of the U.S. population experienced neck or back painin a three-month period, with 14-21% experiencing neck pain. Of thetotal group, 26-33% experienced associated radicular pain in a limb.Remarkably, lumbosacral and cervical pain together caused 5% of all U.S.health care visits in the in 2006.

Costs associated with care of individuals with low back and neck painare huge. For example, in 2006, 44.4 million patients sought medicalattention for low back pain, which was the chief complaint in 45.1million encounters; an additional 13.2 million medical encounters werefor neck pain. Annual cost of back pain in the US is $20-50 billion.Direct medical costs in 2002-2004 for spine problems were $193.9billion, with $30.3 billion attributed specifically to spine pain.Indirect costs of lost wages are estimated at $14 billion annually, andin 2008, 385 million work days were lost due to back pain. The subgroupof patients with pain radiating to the limb, as occurs with discherniation or spinal stenosis, had the highest numbers of bedridden andlost work days. Non-physician health care visits, e.g., physical therapyand other services, numbered 173.5 million from 2002-2004.² Utilizationis increasing, with ambulatory physician visits up 2.5% andnon-physician visits up 10.2% from 1996-1998 to 2002-2004, with totalincrease in health care costs for spine of 24.5% (mean) and 48.9%(aggregate) in the same time period.

Another area our disclosure will address is the muscular health of olderadults, which is the fastest growing segment of the population. Healthcare cost are exceptionally high for older adults with decliningfunction, accounting for a disproportionate fraction of national healthcare expenditures. Muscle weakness is an independent risk factor fordisability and mortality among older adults. Age associated loss ofmuscle mass, known as sarcopenia, is an important factor identified asrelevant to mortality and disability.

In a recent and important editorial on sarcopenia and muscle function,Ferrucci et. al. (L. Ferrucci, R. de Cabo, N. D. Knuth, S. Studenski “OfGreek heroes, wiggling worms, mighty mice and old body builders”, J.Gerontol A Biol Sci Med Sci 2012; 67:13-6, [Ferrucci 2012] which isincorporated herein in its entirety by reference) advocated for aclinical approach in evaluating age associated muscle impairments,stating that after an initial mobility assessment to stratify patientrisk for adverse outcomes (e.g., disability and mortality), musclestrength should be measured and a decision tree assessment used toevaluate muscle quality and function.

Both the general research community and the U.S. Food and DrugAdministration (FDA) recognize the importance of improved biomarkers forneuromuscular disease research to assist with early diagnosis and trackdisease progression over time and response to therapy. Even morefundamentally, the concept of biomarker has expanded beyond its earlierdefinition that was restricted to molecular indices and now includes,but it not limited to, imaging and other methodologies. In fact, the FDAdefines a biomarker as any objective test of disease status that cannotbe influenced by the state of mind of the patient or examiner. The FDArecently developed biomarker definitions including diagnostic biomarkersfor disease identification, response predictive biomarkers for assessingsubgroups of individuals more likely to respond to a specific therapy,and prognostic biomarkers, for evaluating likelihood of disease onset orprogression without any form of intervention. The FDA definitionsprovided herein are for discussions and references purposes only, andare not intended to limit any term contained herein. Two categories ofbiomarkers include response identification biomarkers (also calledpharmacodynamic biomarkers) and biomarkers as surrogate endpoints inclinical trials. As a result, the FDA is revamping its approach to drugapproval based on such surrogate endpoints. Previously, approvaldemanded evidence of change in a clinical outcome measure, such as,e.g., improved physical function or activity. In the future, however, itmay be possible for a biomarker, which is established as a surrogateendpoint in a clinical trial, to obtain “qualification” status throughthe FDA as a surrogate endpoint, helping speed study and approval ofeffective therapies.

One technique for evaluating muscles is intramuscular electromyography(EMG.) EMG includes, but is not limited to, a technique for evaluatingand recording the electrical activity produced by muscles, including,e.g., skeletal muscles. EMG may be performed using an instrument calledan electromyograph, to produce a record called an electromyogram. Anelectromyograph may detect, among other things, the electrical potentialgenerated by muscle cells when the cells are electrically orneurologically activated. The detected signals may be analyzed todetect, among other things, medical abnormalities, activation level,recruitment order or to analyze the biomechanics of human or animalmovement. EMG is exceedingly intrusive in that it uses the insertion ofneedles through the skin and into the muscles and the use of theseneedles to measure electrical potential.

Electrical impedance myography (EIM) is a novel technological approachto effectively address these limitations. Unlike standardelectrophysiological approaches, EIM is less directly dependent uponinherent electrical potential of muscle or nerve tissue. EIM is based onelectrical bioimpedance. It measures the effect of tissue structure andproperties on flow of extremely small, non-intrusive amounts ofelectrical current. Unlike standard bioimpedance approaches, however,measurements can be performed over small areas of muscle and incorporatesophisticated analytic tools. In EIM, electrical current, such as, e.g.,high-frequency alternating current, may be applied to localized areas ofmuscle via electrodes (e.g., surface electrodes) and the consequentsurface voltage patterns may be analyzed. Although data can be obtainedwith off-the-shelf bioimpedance devices, these devices are far fromideal in terms of providing useful data reliably, as discussed in moredetail below.

FIG. 62A illustrates the concepts underlying EIM. Electrical current(sinusoid “a”) is applied via two or more outer surface electrodesgenerating a voltage difference measured by the two or more innerelectrodes (sinusoid “b”). The voltage may be proportional to tissueresistance (R). Myocyte membrane lipid bilayers are capacitive in nature(e.g., they briefly store and then release some or all of the storedcharge) and so exhibit reactance (X), making the voltage sine wave outof phase with applied current wave. Reactance and resistance values maybe combined to obtain the summary phase angle (θ) via the relationshipθ=arctan(X/R). FIG. 62B shows changes seen in diseased or less thanideal muscle tissue. Here, presence of connective tissue, fat andreduced muscle mass, among other things, may increase measuredresistance; muscle fiber atrophy and loss also results in reducedreactance (e.g., timing of voltage sinusoid is now only slightly shiftedrelative to current). Thus, phase angle, as well as the resistance andreactance may be used to measure, e.g., disease progression. As diseaseadvances, reactance and phase angle may decrease whereas resistance mayincrease.

Two additional aspects to EIM may include:

-   -   a) strong frequency dependence of EIM data. Thus, performing EIM        measurements across a range of frequencies may help to        characterize tissue. FIG. 63 shows multifrequency data “d” from        a normal subject and from a patient with advanced ALS (Emory U.        stem cell study), which is denoted by “e”. Note major alteration        in impedance parameters across the frequency spectrum.    -   b) electrical anisotropy—directional dependence of current flow.        Typically, electrical current flows relatively easily along        muscle fibers than across them conferring a readily detectable        anisotropy. Alteration in electrical anisotropy can also be used        as a measure to evaluate muscle tissue to, e.g., determine a        disease state, and early data show that anisotropy increases in,        among other things, ALS.

Although much previous EIM work was done with off-the-shelf whole-bodybioimpedance systems, for example, using these systems for localizedimpedance measurements may be problematic for a variety of reasons,including, but not limited to, the systems: 1) may not be calibrated forthe very different impedances found in localized areas of tissue, suchas, e.g., muscle tissue; 2) may be unable to effectively measure andaccount for muscle anisotropy; 3) rely on multiple, clumsy adhesiveelectrodes that may be slow to apply and result in spacing variability;and 4) may operate over a limited frequency range that may miss certainclinical information. Thus, there is a need for a handheld, rapidlyapplied, broadly capable, robust EIM system for bedside use.

There are some reports of the use of electrical impedance for biometricpurposes. Examples of such uses may be found in: U.S. Pat. No. 6,122,544to L. W. Orgon “Electrical Impedance Method and Apparatus for Detectingand Diagnosing Diseases” (Orgon 544); U.S. Pat. No. 6,768,921 to LeslieW. Organ, K. C. Smith, Reza Safaee-Rad, M. Graovac, G. P. Darmos, and I.Gavrilov, “Electrical impedance method and apparatus for detecting anddiagnosing diseases” (Organ 921); U.S. Pat. No. 6,845,264 and PCTApplication Publication No. WO 00/19894, Skladnev; Victor, Thompson;Richard L., Bath; Andrew R., “Apparatus for recognizing tissue types”,(Skladnev 264); U.S. Pat. No. 6,723,049 and Australian Application No.PR5718, Skladnev; Victor Nickolaevich, Blunsden; Christopher Kingsley,Stella; Rita “Apparatus for tissue type recognition using multiplemeasurement techniques” (Skladev 049); U.S. Pat. No. 7,212,852 to K. C.Smith, J. S. Ironstone, F. Zhang, “Bioimpedance measurement usingcontroller-switched current injection and multiplexer selected electrodeconnection”, (Smith 852); U.S. Pat. No. 7,457,660 to K. C. Smith and J.I. Ironstone “Eliminating interface artifact errors in bioimpedancemeasurements” (Smith 660); U.S. Pat. No. 7,136,697 to Michael G. Singer“Methods for determining illness, progression to death, and/or timing ofdeath of biological entity” (Singer 697); U.S. Pat. No. 7,003,346 toMichael G. Singer, “Method for illness and disease determination andmanagement” (Singer 346); U.S. Pat. No. 8,103,337 to M. Gravovac, J IMarteus, Z. Pavlovic and J. Ironstone “Weighted Gradient Method andSystem for Diagnosing Disease” (Gravovac 337); U.S. Pat. No. 6,631,292to R. J. Liedtke, (Liedtke 292) “Bio-electrical Impedance Analyzer”;U.S. Pat. No. 8,004,291 to Naosumi Waki, “Bioelectric impedancemeasuring circuit”, (Waki 291); U.S. Pat. No. 7,869,866 to GiannicolaLoriga; Andrea Scozzari, “Device for the monitoring of physiologicvariables through measurement of body electrical impedance”, (Loriga866); U.S. Pat. No. 7,148,701 to Sin-Chong Park; In-Duk Hwang;“Apparatus for measuring electrical impedance” (Park); U.S. PatentApplication Publication No. 2010/0292603 and PCT Application PublicationNo. WO/2007/035887 to C. A. Shiffman, R. Aaron and S. Rutkove,“Electrical Impedance Myography” (Shiffman 887); PCT Application No. WO2011/022068 to Seward Rutkove “A Hand-held Device for ElectricalImpedance Myography” (Rutkove 068); U.S. Pat. No. 5,919,142 and PCTApplication No. PCT/GB96/01499 to Boone, Kevin Graham; Holder DavidSimon “Electrical impedance tomography method and apparatus (Boone 142);U.S. Patent Publication No. 2005/0004490 A1 to L. W. Organ, K. C. Smith,R Safaee-Rad, M. Granvac, P. Darmos and I Gavrilov, “ElectricalImpedance Method and Apparatus for Detecting and Diagnosing Diseases”(Organ 490); U.S. Patent Application Publication No. 2005/0197591 to Z.Pavlovic, M Graovuc, J. S. Ironstone, “System and Method forPrebalancing Electrical Properties to Diagnose Disease” (Pavlovic 591);U.S. Patent Application Publication No. 2004/0073131 to L. W. Organ, K.C. Smith, R Sufaee-Rad, M. Graovac, G. P. Darmos and I. Gavrilov,“Electrical Impedance Method and Apparatus for Detecting and DiagnosingDiseases” (Organ 131); U.S. Patent Application Publication No.2004/0167422 to L. W. Organ, R Sufaee-Rad, M. Graovac, K. C. Smith, J.S. Ironstone, “Breast Electrode Array and Method of Analysis forDetecting and Diagnosing Diseases”, (Organ 422); U.S. Patent ApplicationPublication No. 2004/0210157 L. W. Organ, K. C. Smith, R. Safaee-Rad, M.Graovac, G. P. Darmos and I. Gavrilov “Electrical Impedance Method andApparatus for Detecting and Diagnosing Diseases” (Organ 157); U.S.Patent Application Publication No. 2004/0210158 to L. W. Organ, K. C.Smith, R. Safaee-Rad, M. Graovac, G. P. Darmos and I. Gavrilov“Electrical Impedance Method and Apparatus for Detecting and DiagnosingDiseases” (Organ 158); U.S. Patent Application Publication No.2004/0243018 to L. W. Organ, K. C. Smith and J. S. Ironstone, “Apparatusand Method for Determining Adequacy of Electrode-So-Skin Contact andElectrode Quality for Bioelectrical measurements” (Organ 018); U.S.Patent Application Publication No. 2004/0243019 to M. Graovac and Z.Pavlovic, “Weighted Gradient Method and System for Diagnosing Disease”(Graovac 019); U.S. Patent Application Publication No. 2008/0064979 toZ. Pavlovic, M. Graovac and J. S. Ironstone, “System and Method forPrebalancing Electrical Properties to Diagnose Disease” (Pavlovic 979);U.S. Patent Application Publication No. 2008/0076889 to L. W. Organ, R.Safaee-Rad, M. Graovac, K. C. Smith, J. S. Ironstone, “Breast ElectrodeArray and Method of Analysis for Detecting and Diagnosing Diseases”,(Organ 889); and U.S Patent Application Publication No. 2008/0249432 andPCT Application No. PCT/CA04/00458 A to Semlyen and M. Graovac“Diagnosis of Disease by Determination of Electrical Network Propertiesof a Body Part”, (Semiyen 432). All of these patents and patentapplications are incorporated herein in their entirety by reference.

SUMMARY OF THE DISCLOSURE

Embodiments of the present disclosure relate to devices and methods forevaluating bodily tissue, such as, e.g., muscular tissue. Embodiments ofthe present disclosure include living and dead tissue as well as animaland plant tissue.

In one embodiment, a method for measuring a characteristic of a tissueincludes passing a current through the tissue, measuring a signalcorresponding to the voltage resulting from passing the current throughthe tissue, analyzing current passed through the tissue and resultingvoltage to determine the electrical characteristics of the tissue, andanalyzing the electrical characteristics of the tissue to determine astatus of the tissue.

Various embodiments of the method may include one or more of thefollowing features: the status is a health of the tissue; the tissue mayinclude living human tissue; the tissue may include muscular tissue; thecurrent may include alternating current; the frequency of thealternating current may be between 1 kHz and 10 MHz; analyzing thecurrent passed through the tissue may be performed by a devicecomprising an amplifier; the amplifier may be a transimpedanceamplifier; the signal to noise ratio of the measured signal may beenhanced by a device comprising premeasurement drive equalization; thedirection of measuring the signal may not be collinear with thedirection along which the current is passed; the direction ofmeasurement of the signal may be between 60 degrees and 120 degreesrotated from the direction along which the current is passed; thedirection of measurement of the voltage may be between 85 degrees and 95degrees rotated from the direction along which the current is passed;the device may include a plurality of lock-in amplifiers operating inparallel; the method may further comprise measuring and calculating LBTIat a plurality of frequencies simultaneously; the method may furthercomprise verifying a calibration of the device prior to measuring thesignal; the calibration of the device may be verified automatically andthe step of measuring is not permitted to proceed if the calibrationcannot be verified; the step of passing a current through tissue may beperformed by an electrical component having a plurality of electrodecontacts configured to provide electrical contact with a surface of thetissue; the plurality of electrodes may be contained in an electrodeassembly; the electrode assembly may be disposable and is only used fora single series of measurements; the method may further compriseanalyzing the electrode assembly for a prior use; the step of measuringa signal may be prohibited if the electrode assembly was previouslyused; analyzing the electrode assembly for a prior use may be conductedby a mechanical mechanism; analyzing the electrode assembly for a prioruse may be conducted by an electrical method, and wherein the analyzingmay be conducted by electronics within the electrical component; thestep of analyzing the electrode assembly for a prior use may beconducted by remote electronic components; the electrical component mayinclude at least two parts which can be detached, at least one of theparts comprising the electrode assembly; the at least two parts may besecured together by one or more magnets; the at least two parts may besecured to one another by one or both of a friction or interference fit;the step of analyzing the electrical characteristics of the tissue maycomprise the use of Cole parameters; and the use of Cole parameters mayfurther comprise calculating a semi-ellipse to which three of the fourCole parameters are related and using that relationship toreparameterize the problem into two sequential optimizations: aquadratic optimization that computes an optimal circle that fits thedata, and quasi-convex optimization that uses results of theoptimization to find the remaining parameter; the semi-ellipse maycomprise a semi-circle.

In another embodiment, a device for measuring a characteristic of atissue may include a plurality of electrodes; a power supply configuredto be operably coupled to the plurality of electrodes to supply a signalthrough the tissue; analytical electronics configured to be operablycoupled to the plurality of electrodes for analyzing a input current andresulting voltage to determine the electrical characteristics of thetissue; and electronics configured to communicate to a user a result ofanalysis performed by the analytical electronics.

Various embodiments of the device may include one or more of thefollowing features: the signal may include controlled alternatingcurrent; a frequency of the alternating current may be between 1 kHz and10 MHz; the analytical electronics may comprise a transimpedanceamplifier; a signal to noise ratio of the measured signal may beenhanced by a device comprising premeasurement drive equalization; atleast one of the plurality of electrodes may be configured to measurevoltage; a direction of measurement of the voltage may not be collinearwith the direction along which the current is passed; a direction ofmeasurement of the voltage may be between 60 degrees and 120 degreesrotated from the direction along which the current is passed; adirection of measurement of the voltage may be between 85 degrees and 95degrees rotated from the direction along which the current is passed;the device may further comprise a plurality of lock-in amplifiersoperating in parallel capable of simultaneous measurement andcalculation of LBTI at a plurality of frequencies; the device may beunable to measure voltage unless the device is calibrated; the devicemay be configured to be calibrated automatically; the plurality ofelectrodes may be contained in an electrode assembly; the electrodeassembly may be disposable and may be only used for a single series ofmeasurements; the device may be further configured to determine whetherthe electrode assembly was previously used; the device may furthercomprise a mechanical mechanism for determining if the electrodeassembly was previously used; the device may further comprise anelectrical mechanism for determining if the electrode assembly waspreviously used; the electrical mechanism may be disposed in the device;the electrical mechanism may be remote of the device; the device mayinclude at least two parts detachably secured to one another, at leastone of the parts comprising the electrode assembly; the at least twoparts may be secured together by a magnet; the at least two parts may besecured to one another by one or both of a friction or interference fit;the analytical electronics may be configured to analyze the inputcurrent and resulting voltage with the use of Cole parameters; the useof Cole parameters may further comprise calculating a semi-ellipse towhich three of the four Cole parameters are related and using thatrelationship to reparameterize the problem into two sequentialoptimizations: a quadratic optimization that computes an optimal ellipsethat fits the data, and quasi-convex optimization that uses results ofthe optimization to find the remaining parameter; and the semi-ellipsemay comprise a semi-circle.

In other embodiments, there are single subject, disposable sensors to beplaced on the test subject to provide the contact to permit EIMmeasurements to be made. By using a single subject, disposable sensor,cross-contamination and infection are reduced or eliminated. Additionalembodiments can incorporate a pouch of saline solution or a gel block inthe disposable sensor to release fluid and enhance conductivity andreduce impedance during measurements. Additional embodiments can includean absorbent fluid reservoir to supply saline to the surface of thesensor and improve the connection.

Additional objects and advantages of the disclosure will be set forth inpart in the description that follows, and in part will be obvious fromthe description, or may be learned by practice of the disclosedembodiments. The objects and advantages of the disclosure will berealized and attained by means of the elements and combinationsparticularly pointed out in the appended claims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory only,and are not restrictive of the invention, as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate several embodiments of thedisclosure and, together with the description, serve to explain theprinciples of the embodiments disclosed herein.

FIG. 1 is a block diagram of the bioimpedance system.

FIG. 2 is a detailed block diagram of the system.

FIG. 3 is a block diagram of the signal generation and acquisition.

FIG. 4 is a circuit diagram of previously reported example indifferential current driving for impedance measurements.

FIG. 5 is a circuit diagram of previously reported example insingle-ended current driving for impedance measurements.

FIG. 6 is a circuit diagram of a previously reported example forimpedance measurements.

FIG. 7 is a circuit diagram of a transimpedance amplifier.

FIG. 8 is a circuit diagram of a previously reported transimpedanceamplifier.

FIG. 9 is a circuit diagram of a transimpedance amplifier for LBTImeasurements

FIG. 10 is an implementation of a lock-in amplifier using digital signalprocessing

FIG. 11 is a schematic drawing of a portion of voltage sense channel.

FIG. 12 is a Schematic drawing of portion of current sense channel.

FIG. 13 is an example of an LBTI electrode array for CTI and OTImeasurements.

FIG. 14 is an example of electrode array whereby OTI measurements aretaken in the middle ring inner ring.

FIG. 15 is graphs with OTI measurements on meat, TX-151, and meat with alayer of TX-151 placed between it and the electrodes.

FIG. 16 is a drawing of an electrode array topology with a single pairof driving electrodes (black) and two unique pairs of sensory electrodes(white).

FIG. 17 is a drawing of an electrode array topology with the sensoryelectrodes (white) off-center with respect to the drive electrodes(black).

FIG. 18 is a drawing of an electrode array topology with a single pairof driving electrodes (black) and one unique pair of sensory electrodes(white).

FIG. 19 is a drawing of an electrode array topology with a single pairof driving electrodes and two non-unique pairs of sensory electrodesthat can provide one perpendicular measurement.

FIG. 20 is a drawing of an electrode array topology with a single pairof driving electrodes and multiple sensory electrodes that can providemultiple orthogonal measurements.

FIG. 21 is a drawing of an electrode array topology with a single pairof driving electrodes (black), a single pair of orthogonal sensoryelectrodes (white and perpendicular to drive electrodes), and a singlepair of collinear sensory electrodes (white and collinear with driveelectrodes).

FIG. 22 is a drawing of an electrode array topology with one pair ofdedicated drive electrodes (black), one pair of sensory electrodes(white), and one pair of electrodes that can be used for both drive andsensing (gray) to provide both a single collinear (horizontal) and twoorthogonal (vertical) measurement.

FIG. 23 is a drawing of an electrode array topology for multi-angularorthogonal measurements.

FIG. 24 is a drawing of an electrode array topology for multi-angularmeasurements that provide both collinear measurements, severalsingle-pair orthogonal measurements, and two two-pair orthogonalmeasurement.

FIG. 25 is a drawing of an electrode array topology for multi-angularmeasurements that provide both collinear measurements, severalsingle-pair orthogonal measurements, and four two-pair orthogonalmeasurement.

FIG. 26 is a circuit diagram of a simplified LBTI system.

FIG. 27 is a drawing of Electrode Array with some poor contacts (left),with improved contacts but still some poor contacts (middle), and propercontacts (right).

FIG. 28 is a circuit diagram of an example of an anisotropic mesh ofdiscrete resistors and capacitors. In this diagram, the resistors andcapacitors (R2,C2) along the x-axis are in general different than in they-axis (R1,C1).

FIG. 29 is circuit/block diagram showing measuring the anisotropicemulation. In this arrangement, that impedance cells can be placed inseries with the driving and measuring circuits to emulate contactimpedance.

FIG. 30 is a circuit diagram illustrating that the boundaries of themesh can be “wrapped-around” so that y0 is connected to y0 and x0 to x0,xn to xn, yn to yn and so forth to create a topological torus.

FIG. 31 shows a screenshot of schematic capture from LTSpice simulatorof a particular impedance cell topology.

FIG. 32 shows a screenshot of schematic capture from LTSpice simulatorof impedance cells connected as a topological torus.

FIG. 33 is a chart of a comparison of two impedance systems CMD EIM1001and ImpediMed SFB7) against simulation of known impedance network.

FIG. 34 is a diagram of a flexible/adhesive patch electrode interface.The patch may or may not be flexible. The holding arms may or may notrotate. The conducting contacts on the arms and the patch make contactso that the electrodes on the patch are electrically connected to thesystem. The figure shows a cam as the mechanism holding the patch inplace.

FIG. 35 shows drawings of handheld probes and electrode array patches.FIG. 35 (A) shows one embodiment of a handheld probe and electrode arraypatch. FIG. 35 (B) shows another embodiment of a handheld probe andelectrode array pad. FIG. 35 (C) shows top and bottom views of electrodearray pad. FIG. 35 (D) shows a zoomed in image of electrode array withcircles marked 35D10 highlighting the current electrodes and circlesmarked 35D20 highlighting the voltage electrodes that compose the sameconfiguration that was proposed. The other electrodes were added toallow flexibility to select a variety of electrode configurations usingmultiplexers. FIG. 35 (E) shows a side view of electrode array padshowing rubber like material before it conforms to curved surface. FIG.35 (F) shows a side view of electrode array pad conforming to curvedsurface.

FIG. 36 is a diagram of a flexible/adhesive patch electrode interfacewith electrodes arranged in an example format with an example tab (top)containing wires that connect to the electrodes.

FIG. 37 is a diagram of a flexible/adhesive patch electrode interfacewith an example tab (center cut-out) containing wires that connect tothe electrodes.

FIG. 38 is a diagram of a flexible/adhesive patch electrode interfacewith electrodes arranged in an example format and with an exampleflexible backing that contains contacts to make electrical contact withthe back of the patch.

FIG. 39 is a diagram of a multi-layer patch with one end of the pathacting as the face that makes contact with the surface to be measured(bottom) and the other acting as a conducting layer that carries signalsto/from the electrodes to/from a backing (top).

FIG. 40 is an Illustration of a non-patch electrode interface (sideview).

FIG. 41 is an illustration of an individual electrode that is possiblyactively actuated via an electro-mechanical actuator.

FIG. 42 is a drawing of an electromagnet Constant Force Actuator and isnot drawn to scale.

FIG. 43 is a drawing of Digitally Controlled Electromagnetic Actuators

FIG. 44 is a circuit diagram of a Current Output Power Amplifier.

FIG. 45 is Illustration of a passive spring actuation support systemattached to the electrode interface of FIG. 37.

FIG. 46 is an Illustration of an example of the system attaching to theelectrode interface of FIG. 37 via a hook-and-loop interface.

FIG. 47 is a cut away illustration of a constant force actuator

FIG. 48 shows a magnetic constant-force actuator fully retracted andextended.

FIG. 49 is a circuit diagram of a transimpedance amplifier.

FIG. 50 is a chart shows a comparison of the EIM 1001 vs SFB7 againstsimulation of known impedance network.

FIG. 51 is a chart showing Impedance amplitude over angle for theorthogonal configuration. Measured data is green. Sinusoidal fit isblue.

FIG. 52 is a chart showing Impedance amplitude over angle for the inlineconfiguration. Measured data is green. Sine-squared fit is blue.

FIG. 53 is a chart showing one sampled phase response using only 3points/decade and linear interpolation. Error between the oversampled(red, dashed) and downsampled response (black, solid) is negligible.

FIG. 54 is a chart showing impedance magnitude of a piece of meat (flanksteak) after successive slicing and tenderization. H is the healthyresponse, S is response after slicing, ST after slicing and tenderizing,and so on. Points are measurements and the curves are interpolations.

FIG. 55 is a chart showing impedance magnitude for orthogonalmeasurement at 50 kHz for TX151, bare meat and meat with TX151.

FIG. 56 is a simplified block diagram of the electronic system. The DSPinterfaces with a PC through a USB cable.

FIG. 57 shows the graphical user interface. (A) shows the startup pagerequesting site and patient information and requiring operator tocertify that the protocol has been followed. (B) shows the data displaypage showing four overlaid measurements. Data can be displayed by round,muscle, and trial. Also, simple error checking is conducted to ensurehigh quality data.

FIG. 58 shows (A) the EIM1101 netbook and handheld probe. The probe isconnected to the laptop through isolated USB. (B) a front view ofhandheld probe with front cover detached. The “CFA disabler” snaps ontothe base to disable the CFA, allowing analysis on the effect of constantforce actuation on quality data. (C) an isometric view of handheld probeshowing the constant force spring along with the linear guide and railused to implement constant force actuation. (D) the bottom side ofhandheld probe showing magnets used to hold the electrode array inplace, the pogo pins used to make electrical connection to the electrodearrays, and an electrode array with metal disks that snap onto magnets.

FIG. 59 shows the constant force actuator at different states: (A) hasno force applied; (B) has some force applied, but not enough to causedisplacement; (C) has just enough force to cause displacement; (D) ishalf-way displaced; (E) is nearly fully displaced. Note that in therange of displacement, the force is between 1319 grams and 1329 grams, avariation of only 0.75%.

FIG. 60 shows at left the electrode array pressed against gastrocnemiusmuscle of healthy subject. On right is a zoomed in image showingelectrode array pad conforming to a healthy subject's biceps.

FIG. 61 is a graph showing Cole interpolation of data from muscles ofhealthy (blue, right) and ALS subjects (red, left).

FIG. 62 is drawings showing EIM Measurements of healthy and diseasedmuscles.

FIG. 63 is a graph showing frequency dependence of EIM Measurements ofhealthy and diseased (ALS) muscles.

FIG. 64 shows an exploded view of the disposable sensor.

FIGS. 65, 66 and 67 show different views of the assembled disposablesensor.

FIG. 68 shows another exploded view of the disposable sensor with salinepouch recess.

FIG. 69 shows an exploded view of the disposable sensor without salinepouch recess.

FIG. 70 shows the assembled device.

FIG. 71 shows the sensor, absorbent fluid reservoir and package.

FIG. 72 shows an exploded view of the absorbent fluid reservoir andsensor.

FIG. 73 the device with a sensor resting on a vacuum formed stand.

FIG. 74 shows two views of a device with a sensor and absorbent fluidreservoir resting on a stand.

FIG. 75 shows an exploded view of—Foam—Pre wetted and skinned foamblock.

FIG. 76 shows foam prewetted and bagged.

FIG. 77 shows surface strips/pads wipe.

The figures also are in U.S. patent application Ser. No. 14/826,134filed Aug. 15, 2015 (US Patent Application publication 20160038053), andin U.S. patent application Ser. No. 13/842,698 filed Mar. 15, 2013, (USPatent Application publication 20130338473) now U.S. Pat. No. 9,113,808all of which are incorporated herein in their s entirety by reference.

DETAILED DESCRIPTION OF THE DISCLOSURE Overview of Embodiments

One aspect of the disclosure involves a method for measuring the healthof a tissue, such as, e.g., muscular tissue. Another aspect involvesmeasuring the health of living human tissue. Another aspect involvesmaking measurements with the use of alternating current. Another aspectinvolves alternating current between 1 kHz and 10 MHz. Another aspectinvolves analysis of input current by a device with a transimpedanceamplifier. Another aspect involves measurement where signal to noiseratio is enhanced by premeasurement drive equalization. Another aspectinvolves measurement where the direction of measurement of the voltageis not collinear with the direction along which the current is passed.Another aspect involves measurement where the direction of measurementof the voltage is between approximately 60 degrees and approximately 120degrees rotated from the direction along which the current is passed.Another aspect involves measurement where the direction of measurementof the voltage is between approximately 85 degrees and approximately 95degrees rotated from the direction along which the current is passed.Another aspect involves verification of calibration of the system priorto initiation of measurements. Another aspect involves verificationwhere the calibration is verified automatically and the measurement isnot permitted to proceed if the calibration cannot be verified. Anotheraspect involves measurement where there are electrodes to provideelectrical contact with the surface of the tissue. Another aspectinvolves containing the electrodes in an electrode assembly. Anotheraspect involves an electrode assembly which is disposable and is onlyused for a single series of measurements. Another aspect involves theverification of the single use of the disposable electrode assembly andnot permitting the measurement to proceed if the verification fails.Another aspect involves the verification of single use being amechanical method. Another aspect involves verification of single use byan electrical method in which the verification occurs locally in themeasurement device. Another aspect involves verification of single useby an electrical method in which the verification involves a remotemeasurement or comparison. Another aspect involves the device holdingthe electrodes having at least two parts which can be detached. Anotheraspect involves the two parts of the device holding the electrodes beingheld together by a magnetic mechanism. Another aspect involves the twoparts of the device holding the electrodes being held together by theuse of molded or machined sections frictionally held together, such as,e.g., by snap-fit. Another aspect involves analyzing tissue with the useof Cole parameters. Another aspect involves the use of Cole parameterswith calculating a semicircle to which three of the four Cole parametersare related.

Still another aspect of the disclosure involves a device for measuringthe health of a tissue. Another aspect involves a device usingcontrolled alternating current. Another aspect involves a device withalternating current between approximately 1 kHz and approximately 10MHz. Another aspect involves a device with analysis of input current bya device with a transimpedance amplifier. Another aspect involves adevice with measurement where signal to noise ratio is enhanced bypremeasurement drive equalization. Another aspect involves a device withmeasurement where the direction of measurement of the voltage is notcollinear with the direction along which the current is passed. Anotheraspect involves a device with measurement where the direction ofmeasurement of the voltage is between approximately 60 degrees andapproximately 120 degrees rotated from the direction along which thecurrent is passed. Another aspect involves a device for makingmeasurements where the direction of measurement of the voltage isbetween approximately 85 degrees and approximately 95 degrees rotatedfrom the direction along which the current is passed. Another aspectinvolves a device with verification of calibration of the system priorto initiation of measurements. Another aspect involves a device withverification where the calibration is verified automatically and themeasurement is not permitted to proceed if the calibration cannot beverified. Another aspect involves a device with electrodes contained inan electrode assembly. Another aspect involves a device where anelectrode assembly which is disposable and is only used for a singleseries of measurements. Another aspect involves a device whereverification of the single use of the disposable electrode assembly andnot permitting the measurement to proceed if the verification fails.Another aspect involves a device where the single use of the electrodeassembly is verified by an electrical or mechanical means and themeasurement is not permitted to proceed if the verification fails.Another aspect involves a device with the verification of single usebeing a mechanical method. Another aspect involves a device withverification of single use by an electrical method in which theverification occurs locally in the measurement device. Another aspectinvolves a device with verification of single use by an electricalmethod in which the verification involves a remote measurement orcomparison. Another aspect involves the device holding the electrodeshaving at least two parts which can be detached. Another aspect involvesthe two parts of the device holding the electrodes being held togetherby a magnetic mechanism. Another aspect involves the two parts of thedevice holding the electrodes being held together by the use of moldedor machined sections which snap together. Another aspect involves adevice where analyzing tissue uses of Cole parameters. Another aspectinvolves a device where analyzing tissue uses Cole parameters withcalculating a semi-circle to which three of the four Cole parameters arerelated.

Description of the System

FIG. 1 illustrates a system for, among other things multi-angle,multi-frequency, localized biological transfer impedance (LBTI)measurements. For purposes of discussion, transfer impedance mayinclude, but is not limited to, the ratio of the voltage applied at oneor more terminals in a network to the current measured by one or moreother terminals in the network. In addition, transfer impedance mayinclude, but is not limited to, the ratio of a voltage measured acrossone or more terminals in a network to the current applied to one or moredifferent terminals.

In contrast with whole-body transfer impedance measurements (alsoreferred to as “whole body bioimpedance”), which yield information aboutthe entire body of a subject, LBTI measurements capture informationrelating to one or more particular regions of the subject, for example.Localized biological transfer impedances may include, but is not limitedto, transfer impedance measurements made over one or more localizedareas of biological tissue including parts of a living body. Forexample, an LBTI measurement performed on the surface of a patient'sbicep would yield information regarding, among other things, skin,subcutaneous fat, and muscle tissue directly below and in the immediatevicinity of the electrodes used in the measurement.

LBTI measurements have been used to extract physiological information inhuman subjects that correlate to fluid status, body-mass index, cardiacoutput, and neuromuscular disease. The disclosure described hereincludes, but is not limited to, a system and method for taking LBTImeasurements of a type which are previously unknown. The system indepicted in FIG. 1 illustrates one embodiment of the disclosurecomprising a handheld probe (203), a computing device (113), a display(114), and an electrode array (101) as the primary components.

The handheld probe (203) may include a mechanical housing (204), anelectronic system (100), and an electrode array interface mechanism(201). FIG. 2 illustrates parts of the disclosure in more detail. Theelectrode array (101) may be used to make contact with physiologicalmaterial; typically the surface of a patient's skin. The electrode array(101) may include a plurality of electrodes, some of which may be usedto apply an electrical signal such as current or voltage, and othersthat are used to sense an electrical signal such as voltage or current.One or more of the plurality of electrodes in the electrode array (101)may be selectively activatable.

An electrode interface can be used to connect the electrodes to asuitable electronic system and may include features such as constantforce actuation to control the amount of force applied by the electrodesto the material. Multiplexers, cross-point switches, relays, or othertypes of switching mechanisms (102, 104, 105) may be used to switch theconnection between different electrodes and different components in theelectronic system such as the signal source channel (106), one or morevoltage sense channels (115-117), or a current sense channel. Each ofthese channels (106, 110, 115-117) may connect to a suitable signalprocessor, including, e.g., a digital signal processor (DSP, 111) thatmay be implemented in a field-programmable gate array (FPGA), amicroprocessor, or similar. In one embodiment, the DSP may interfacewith a computing device (113) such as a personal computer, notebook,laptop, personal digital assistant (PDA), smart phone, or other similardevice capable of executing one or more algorithms. The connectionbetween the DSP and computing device (113) may be implemented using acable, such as a universal serial bus (USB), or a wireless connection,including, but not limited to, WiFi, Bluetooth, and radio frequency. Inanother embodiment, the DSP and computing device may be combined into asingle device embedded within the handheld probe (203).

Electronics for Signal Generation and Acquisition

In one embodiment of the disclosure, only a single voltage channel maybe used to measure the voltage difference between two electrodes in theelectrode array. However, there may be cases where measuring the voltagedifference between more than one pair of electrodes simultaneously isdesirable to expedite a full measurement sweep or synchronize betweenchannels. In such cases, the voltage sense channels may be identical.However, they may also be different if, for example, the amplitude orfrequency range of the signals at the input of each channel is expectedto differ.

Without intending to be limiting, FIG. 3 shows one possibleimplementation of the device with a signal source channel (106), avoltage sense channel (115), and a current sense channel (110) for animplementation where a single voltage sense channel is used. Again,without intending to be limiting, one configuration of the components ofthe signal source channel may include a digital-to analog converter(DAC, 119), a variable-gain amplifier (VGA, 120), and a current limiter(121). The DAC may be used to generate an analog electrical signal usingdata received from the DSP (111). Specifically, the DSP may include awaveform generator (118) such as a direct digital synthesizer (DDS) oran arbitrary waveform generator. The analog electrical signal generatedby the DAC may be amplified or otherwise conditioned using VGA (120) sothat the amplitude of the signal applied to the patient can becontrolled.

The amplitude setting of the VGA can be set digitally by the DSP orthrough any other suitable mechanism. The VGA can also take part of afeedback loop to control the amount of current applied to the patient orthe amplitude of the voltage at the input of the voltage sense channel(115). The output of the VGA can be a current or a voltage, and it maybe passed through a current limiter to ensure that the amount of currentdelivered to the subject is never greater than some threshold. This isimportant since safety regulations require limits on electrical signalsapplied to subjects, and also to ensure that other electronic componentsaffected by this waveform do not saturate. The output of the currentlimiter connects to the multiplexer (102) which directs the current toone or more electrodes in the electrode array.

In one embodiment of the disclosure, the voltage sense channel (115)comprises, but is not limited to, a fully differential instrumentationamplifier (IAMP, 122) (however, any suitable amplifier may be usedwithin the principles of the present disclosure), a fully differentialVGA (123), a fully differential filter (124), and an analog-to-digitalconverter (ADC, 125). Any other suitable electronic components may beincluded. The use of fully differential signaling has the benefit ofreducing the influence of common-mode noise. The main purpose of theinstrumentation amplifier (IAMP) is to amplify differential voltagesignals between desired pairs of electrodes in the electrode array. Thedesign and selection of the IAMP will represent number ofconsiderations, including, e.g., a balance and tradeoffs among at leastthe following characteristics: (i) low input-referred noise to minimizesignal corruption; (ii) high input impedance to minimize the effects ofcontact impedance on the accuracy of the measurements and to minimizecurrent measurement errors; and/or (iii) high bandwidth that issignificantly higher than the desired signal's highest frequencycontent.

It is well known that operating an amplifier near its bandwidth canresult in phase distortion. Using higher bandwidth IAMPs may result inless phase distortion. In some embodiments of the disclosure, aplurality of subsequent amplifier stages can be used. In FIG. 3, asecond stage VGA (123) is used to amplify the voltage signal furtherwith optional amplitude control. Distributing the total gain of thevoltage amplification channel into multiple stages has the benefit ofimproving the frequency response of the system. It is well known thatmost amplifiers present a tradeoff between gain and bandwidth. Bysplitting the system gain into multiple stages, less gain can be usedfor each amplifier resulting in an overall higher bandwidth for thesystem. This results in higher amplitude and phase accuracy for thesystem at higher frequencies.

In one embodiment of the disclosure, a filter (124) is used in thevoltage sense channel. The filter may be active or passive, and it mayprovide additional gain. One purpose for the filter is to provideanti-aliasing before digitizing the signal using an ADC. More generally,the filter removes unwanted noise and interference from the measuredelectrical signal. The ADC (125) in the voltage sense channel is used todigitize the measured waveform. Its output is connected to the DSP fordigital signal processing. In one embodiment of the disclosure, thesampling rate of the ADC may be higher than the Nyquist rate (e.g.,twice the frequency of the highest frequency component of the desiredsignal). In another embodiment, the ADC may be operated at a lowersampling rate such that the signal is “sub-sampled”. This will result inaliasing which is commonly undesirable. However, under somecircumstances, the desired information may still be retrieved despitealiasing. For example, if the signal is sinusoidal, aliasing will resultin frequency translation of the signal to a predictable basebandfrequency where information can still be recovered from it. Sub-samplingmay have the benefit of reducing power consumption in the system orallowing the use of a more accurate ADC since there is often a tradeoffbetween the maximum sampling rate of an ADC and the accuracy (measuredin signal-to-noise ratio (SNR), dynamic range, or effective number ofbits).

In another embodiment of the disclosure, the current sense channel (110)comprises a transimpedance amplifier (TIA) with differential output(106), a fully differential VGA (107), a fully differential filter(108), and an ADC (109). The description of the VGA, filter, and ADC inthe current sense channel 110 is the same as for the voltage sensechannel 115. In one embodiment of the disclosure, components 107-109 inthe current sense channel may be substantially matched to components123-125 in the voltage sense channel. Since transfer impedances may begenerally calculated by taking the ratio of a measured voltage to ameasured current, it is important to minimize or match any amplitude orphase error introduced by the instrumentation. By using matchedcomponents in the two channels, phase and gain errors can be matched inthe current and voltage measurements and then cancelled when ratios aretaken.

Transimpedance Amplifier

A transimpedance amplifier may include, but is not limited to, anamplifier that converts an input current to an output voltage. In someembodiments, the input may include a characteristically low inputimpedance, which may serve to effectively shunt parasitic inputcapacitances. Tetrapolar impedance measurements may be made with, e.g.,four electrodes: two for driving a current and two for sensing thevoltage. Traditionally, the drive electrodes are driven by a truecurrent source, which in theory has infinite impedance, butpragmatically, needs only to have a relatively (such as, e.g., >10times) higher impedance than any other pertinent impedance in themeasurement.

In practice, there are several important considerations in performingthis measurement. For example, real voltage amplifiers may require acommon-mode potential reference, which partially constrains voltages towithin the input range of the amplifiers. Typically, this reference maybe connected with a low impedance, to reduce common-mode interferencefrom external sources that may drive the amplifier inputs outside of itsrange. A further consideration may be that the impedance to thisreference is relatively lower (such as, e.g., <100 times) than the inputimpedance of the amplifier, and that input stage of the amplifier notonly be biased properly, but also so that asymmetries in the inputimpedance will not cause an unacceptable error. The accuracy of atetrapolar measurement relies on how well the current through thematerial under test can be determined. In the following illustrations,the contact impedance may be ignored to highlight the effect of aperformance-dominating source impedance.

FIG. 4 illustrates a previously reported (Grimnes, S. and Martensen, O.G. “Bioimpedance and Bioelectricity Basics”, Acad. Press, Burlington,Mass. 2008 (Grimnes 2008) which is incorporated herein in its entiretyby reference) example in differential current driving for impedancemeasurement. Differential current driving could be part of element 100of FIG. 1 and element 106 of FIG. 2. I₁ may be a current source and I₂may be a current sink with equally opposite polarity. In practice, it isdifficult to match these currents and resulting current offset (I_(cm))appears through the potential reference (V_(cm)) causing errors. R_(big)is the Thevenin equivalent resistance for a practical current source.MUT is the material-under-test through which current (I_(test)) ispassed. I_(test) is not necessarily I₁ nor I₂ nor a combination of thesebecause of the current path through the parasitic capacitance (C_(par)),along with I_(cm). This constitutes an error that increases linearlywith frequency above ½*2πR_(big)C_(par). True impedance of MUT isz=V_(test)/i_(test)

FIG. 5 illustrates a previously reported (Grimnes 2008) single-endedcurrent driving for impedance measurement. Because the current sink isground or suitably low impedance, error between I_(test) and I₁ isthrough a single capacitor C_(par). Bandwidth penalty is half of that ina differential current drive.

FIG. 6 illustrates a previously reported design [O. T. Ogannika, M.Scharfstein, R. C. Cooper, H. Ma, J. T. Dawson and S. Rutkove, “AHandheld Electrical Impedance Myography Probe for the Assessment ofNeuromuscular Disease”, 30^(th) Annual International IEEE EMBSConference, Vancouver, BC, Canada, Aug. 20-24, 2008. (Ogannika 2008)which is incorporated here in its entirety by reference] in which avoltage signal is used to induce a current through the MUT instead ofdirectly applying a current signal using a current source. A voltagesource is defined to have a negligible Thevenin impedance (R_(small)),which is much smaller (<100 times) in magnitude than the impedance ofMUT. The current through the material is now a derived quantity to bemeasured. In this case, it is the voltage across R_(sense). BecauseR_(small) is negligible, the bandwidth limitation is determined byR_(sense). How small R_(sense) can be is limited by the input-referrednoise from the signal path following V_(sense). Smaller values ofR_(sense) will result in better frequency response characteristics sincethe pole created by C_(par) and R_(sense) will be at a higher frequency.However, the resulting voltage V_(sense) will be smaller and moresusceptible to noise. A larger value of R_(sense) will result in worsefrequency response characteristics, but better signal-to-noisecharacteristics at lower frequencies.

FIG. 7 illustrates an embodiment of our disclosure involving a deviceusing a voltage drive with a transimpedance amplifier as both a lowimpedance sink and current measuring device. The input of a closed-looptransimpedance amplifier is designed to have a low input impedance(e.g., <100 times smaller than MUT) over the specified measurementbandwidth. Because of this, the errors caused by current shuntingthrough parasitic capacitances (C_(par)) are negligible.

FIG. 8 illustrates a previously reported [Grimnes 2008] embodiment of atransimpedance amplifier. It consists of a voltage input operationalamplifier with a feedback resistor (R_(f)) and a compensation capacitor(C_(comp)). These transimpedance amplifiers suffer from poor bandwidthat large transimpedance gains (R_(f)) and parasitic capacitances(C_(par)), because C_(par) and R_(f) form a pole in the feedback path,which can fall below the loop crossover and cause instability. Thesolution is to use a lead compensation capacitor, but this introduces aclosed-loop pole that severely limits the bandwidth.

Our disclosure entails the use of a transimpedance circuit in an LBTIapparatus that converts a current to a voltage and having at least thefollowing properties:

-   -   1. The output voltage may be an accurate and reproducible        representation of the input current, although not necessarily        linear;    -   2. The transimpedance circuit may be stable over a wide        frequency range (approximately 1 kHz to approximately 10 MHz,        for example) despite relatively high parasitic capacitance Cpar        (up to approximately 100 pF, for example).    -   3. The transimpedance amplifier may be capable of converting an        input current to an output voltage without introducing        significant phase delay, phase error, or phase distortion over        the desired frequency range (a typical target for phase error is        less than approximately 1°)    -   4. The input to the circuit has low impedance (e.g., <100 times        smaller than MUT).

FIG. 9 depicts an embodiment of a transimpedance amplifier for LBTI forwide bandwidth impedance measurement, in accordance with principles ofthe present disclosure. The amplifier may include a current (such as,e.g., alternative current (AC)) signal input and voltage outputproportional to input. Within the amplifier passband,V_(out)=I_(input)*R_(fb). C_(in) is a dc blocking capacitor. Q₁ may beconfigured as a common-base input stage biased by V_(bias) and currentthrough Q₂. While bipolar transistors are shown for Q₁ and Q₂, manytypes of transistors could be used instead, including complementarymetal-oxide semiconductors (CMOS) or junction gate field effecttransistors (JFET). Effective open-loop input resistance at the emitterof Q₁ is the reciprocal of the transconductance ofQ₁(g_(m)=I_(bias)/V_(t)).

AC current through the emitter of Q₁ appears at its collector andresults in an AC voltage drop across R_(g) that is amplified by U₁. U₁is a wide bandwidth voltage amplifier with open loop gain A, which mustbe much greater than unity in the amplifier passband. The overall openloop gain may be approximately

$L = {\frac{R_{g}}{R_{fb}}{A.}}$

The input current through R_(fb) may be attenuated by a factor ofK=L/(1+L); for large L, K is nearly unity, which makes the outputvoltage proportional to the input current. C_(comp) may be used toimprove the phase margin of the overall amplifier.

The combination of Q₂, R_(B), and R_(E) behaves as a voltage-controlledcurrent source (VCCS). R_(E) serves the purpose of increasing theeffective resistance at the collector of Q₂ and reducing the shot noisecontributed by Q₂ [Avestruz, A-T, Rodriguez, J. I., Hinman, R. T.,Livshin, G., Lupton, E. C., and Leeb, S I. B., “Stability considerationsand performance of wide dynamic range, ambient light active rejectioncircuits in photodiode receivers” Proc. Of Am. Control Conf., 2004.(Avestruz 2004) which is incorporate herein in its entirety byreference]. This VCCS is controlled by an integrator composed of U₂,C_(I), and R_(I), which in the closed-loop both sets the high passcorner frequency for the amplifier and direct current (DC) level at theoutput. The following are the components for FIG. 9:

Q1 & Q2: BFP405 U1: ADA4899 U2: 0PA357 Rg = 430 Ohms RE = 300 Rfb = 430RI = 10 k CI = 1 uF RB = 5 k Ccomp = not placed Cin = 10 uFCpar is a parasitic capacitance, not placed by design. It is typicallysmaller than 100 pF. A benefit of this type of transimpedance amplifieris that the open-loop pole that is created with C_(par) is a function ofthe effective resistance r_(e1)=1/g_(m1) instead of R_(fb). A typicalvalue for r_(e1) is 5 Ohms, while a typical value for R_(fb) is 500Ohms. The open-loop pole is approximately 100 times larger when thetransimpedance amplifier in FIG. 9 is used, and as a result, the circuitbandwidth can be made much higher. Operational amplifier U₁ can be avoltage-input type or current-input type.

Digital Signal Processing

The digital signal processor (DSP) shown as element 111 of FIG. 9 andelement 122 of FIG. 3 performs multiple functions. For example, onefunction may be to extract certain information from the digitizedsignals taken from the ADCs (109, 119, 125, etc.). One method formeasuring transfer impedance is to apply a sinusoidal signal to tissue,and measure the resulting sinusoidal current and voltages that result atdifferent electrodes. Transfer impedance may include, but is not limitedto, the ratio of the measured differential voltage and the measuredcurrent. A sinusoid can be represented by three parameters: amplitude,frequency, and phase. When measuring transfer impedance, the material istypically assumed to be linear, and as a result, the frequency of themeasured signals is the same as the frequency of the applied signalwhich is known. Characteristics in the system, however, will change thesignal amplitude and phase. Therefore, the two exemplary parameters toextract may include, but are not limited to, amplitude and phase. Insome embodiments, transfer impedance amplitude may equal to theamplitude of measured voltage and amplitude of the measured current. Thetransfer impedance phase may equal to the difference between measuredvoltage phase and current phase.

FIG. 10 shows one implementation of another element of ourdisclosure—use of a digital lock-in amplifier. Using equations shown inFIG. 10, for example, amplitude and phase of a digital sinusoidal signalat the output of an ADC can be calculated. Signal phase is relative tophase of a reference oscillator or oscillators. For example, in FIG. 10,two oscillators are shown whose outputs are 90° out of phase. Those ofordinary skill may recognize that any suitable number of oscillators maybe used.

By using a lock-in amplifier like the one shown in FIG. 10 to calculateamplitude and phase of measured current and voltage, transfer impedancecan be easily calculated. For example, if amplitude of measured voltagesignal is A_(V) and amplitude of measured current signal is A_(I), thenamplitude of transfer impedance is A_(Z)=A_(V)/A_(I). Likewise, phase oftransfer impedance would be φ_(Z)=φ_(V)−φ_(I).

Another element of the disclosure includes multiple “lock-in” amplifiersoperating in parallel so that LBTI can be measured and calculated atmultiple frequencies simultaneously. In such an embodiment, the drivesignal is the sum of N_(sig) sinusoids at each at a different frequency.For linear materials, such as human tissue, the resulting voltage andcurrent signals will also comprise a sum of N_(sig) sinusoids, but theamplitudes and phases of each sinusoid may be different. The measuredvoltage and current signals are each passed through N_(sig) lock-inamplifiers, with the reference oscillators of each lock-in amplifiertuned to one of the N_(sig) frequencies of the drive signal. This allowsthe simultaneous FTI calculation at multiple frequencies which canresult in faster measurements. FTI may include, but is not limited to,four-port transfer impedance which means given at least one pair ofdrive electrodes, and at least one pair of voltage sense electrodes, theratio of the differential voltage to the driven current. In thealternating-current (AC) case, voltages and current are complex numbers,and so the transfer impedance is a complex number.

Drive Equalization Using a Pre-Measurement

A purpose of this element of the disclosure is to maximizesignal-to-noise (SNR) of impedance at each frequency measurement pointand for each electrode configuration. As outlined below, we perform afirst scan (pre-scan) over frequency using a small current drive toavoid saturating any of the electronics. The scan can be performedquickly by reducing the integration window (which is an integer numberof sinusoidal drive cycles), and hence increasing bandwidth andsubsequent channel settling speed. To increase scan speed further, fewerfrequency points can be measured if the expected transfer functionresponse of the material-under-test is smooth; in this case, aninterpolation, or other approximation method is sufficient whendetermining drive level for actual high resolution measurement.

The results of this pre-scan may be measured current and voltage data atspecified frequencies. The voltage drive at each frequency may bedetermined based on, among other things, the following constraints:

${maximize}\mspace{14mu} V_{drive}\mspace{14mu} {such}\mspace{14mu} {that}\mspace{14mu} \left\{ \begin{matrix}{V_{meas} < {\alpha \; V_{sat}}} \\{I_{meas} < {\beta \; I_{sat}}}\end{matrix} \right.$

where V_(sat) and I_(sat) are the voltage and current where themeasuring system saturates, and α and β are margins that depend on theexpected accuracy of the pre-scan. In general, using the informationfrom the pre-scan, two separate high resolution scans that separatelymaximize the SNR of the real (in-phase) and imaginary (quadrature)channel are possible.

The two figures below show a more detailed example of a portion of thevoltage sense channel (FIG. 3, element 115), and the current sensechannel (FIG. 3, element 110).

The following components are used in FIG. 11:

  902—ADA4817-2 (two opamps in one package) 904—ADA4817-2 (two opamps inone package) 906—Dual opamp: OPA2683 908—Differential opamp: ADA4938-2

The following are the component values in FIG. 12:

  910—Proprietary transimpedance amplifier with a gain of 430 Ohms(shown in FIG. 9) 912—Differential opamp: ADA4938-1 914—Dual opamp:OPA2683 916—Differential opamp: ADA4938-2

The details of a specific implementation of the pre-measurementdisclosure are outlined below.

The VGA that controls drive signal amplitude is digitally controlled andhas a range of settings Nvga=0-4095, where a setting of Nvga=0 resultsin a signal amplitude of 0, and a setting of Nvga=4095 results in amaximum signal amplitude. The VGA output may be connected to a suitableresistor that limits current to a peak max of I_(max). The peak-to-peakmaximum amplitude at the resistor is V_(max) (occurs when Nvga=4095).The peak-to-peak amplitude at the surface of the skin is a function ofthe current limiting resistor, the contact impedances, the tissueimpedance, and any other impedance in the signal path.

The upper bound of the dynamic range of the voltage sense channel andcurrent channel are set by the ADC input range. The largest inputvoltage “V_(sat)” is equal to the largest input voltage to the voltageADC divided by the gain of the voltage channel. Specifically, if the ADCrange is V_(ADC) and the gain of the voltage chain is G_(V), the largestinput voltage signal is V_(ADC)/G_(V). Likewise, the current channelgain is G_(I), so the largest input current is “I_(sat)” which is equalto V_(ADC)/G_(I). The ratio of V_(sat) to I_(sat) creates an impedancevalue defined as Z_(sat)=V_(sat)/I_(sat). When the measured FTI value islarger than Z_(sat), the voltage channel sets the maximum current thatcan be applied to the tissue, since the voltage at the input of thevoltage channel ADC is larger than for the current channel ADC. If themeasured FTI is smaller than Z_(sat), the current channel sets the limitof the applied current.

Exemplary Method:

-   -   1. Set Nvga0=100    -   2. Select one electrode configuration and one frequency and        apply signal to tissue.    -   3. Set the integration window of the “lock-in” amplifier to a        desirable value that can be smaller than the typical setting.    -   4. Measure the differential voltage between the two voltage        electrodes (V_(meas)), and the current into the TIA (I_(meas)).    -   5. Calculate Z_(meas)=V_(meas)/I_(meas)    -   6. If Z_(meas)>Z_(sat), then set Nvga=Nvga0*V_(meas)/V_(sat)*α    -   7. If Zm<Zcal, then set Nvga=Nvga0*Im/I_lim*alpha, where alpha        is some “backoff” value like 0.9.    -   8. Either store the new Nvga value in a table for subsequent        use, or use that value immediately to modify the VGA setting and        run a new measurement.    -   9. Adjust the integration window for the desired data quality    -   10. Measure Vm and Im again with the new VGA setting and        integration window    -   11. Calculate FTI parameters (amplitude, phase, R, X, etc)    -   12. Repeat these steps for every electrode configuration and        frequency. Since the purpose of this is to approximately        maximize SNR without saturating the ADCs, data quality of the        first sweep does not need to be very high. To expedite overall        measurement, the integration window can be made substantially        shorter during the first sweep (step 4), and then larger during        the second sweep (steps 9-11).

Electrode Array

FIG. 13 and FIG. 14 above show a sample electrode array configuration inwhich a plurality of Collinear Transfer Impedance (CTI) and (OrthogonalTransfer Impedance) OTI measurements are made with a single placement ofthe electrode array. CTI may include, but is not limited to, FTI withall electrodes being (approximately) collinear. On the other hand, OTImay include, but is not limited to, FTI with the line connecting thevoltage sense electrodes (approximately) orthogonal to the lineconnecting the drive electrodes.

The table in FIG. 13 shows the different configurations of electrodesthat result in CTI or OTI measurements. For example, #1 refers to theconfiguration where electrode S1 supplies a signal (signal source), andelectrode I1 is used to sink and measure current. Voltage measured, V1,may be the voltage difference between electrodes VP1 and VM1. Thisparticular configuration is a CTI measurement. Configurations #2, 7, and9 are for similar types of measurements, but at approximately 45°, 90°,and 135° rotations, respectively, compared with #1. Configuration #2uses source and sink electrodes S1 and I1, but measures the voltagedifference V3, between VP3 and VM3 which are positioned on a line thatis rotated 90° with respect to the line connecting S1 and I1. Thisresults in an OTI measurement. Configurations #5, 8, and 11 are similar,but with different rotations. Configuration #4 is similar to #3, exceptthe voltage measurement V5 is made between electrodes VM6 and VP5 andVM5 which are spaced differently than VP2 and VM2. Likewise,configuration #6 is similar to #5, except the voltage electrode arespaced differently.

Benefits of OTI Measurements

One embodiment of OTI measurements results in low FTI values whenelectrodes are approximately aligned with direction of anisotropy in amaterial. In this embodiment, maximal OTI values result when source/sinkelectrodes are aligned approximately 45° with respect to direction ofanisotropy. If electrode S1 and I1 are aligned with direction ofanisotropy, measurements made with configurations 2 and 8 should resultin low FTI magnitude values and FTI phase values approximately equal to90°. Deviations from these expected values would indicate improperalignment between the electrode array and the material being tested. Asa result, these configurations can verify proper alignment and/ordetermine which of the several sets of electrodes will yield the mostvaluable and useful results for a particular electrode array placementand/or determine relative alignment of the electrode array to thedirection of anisotropy. This type of configuration reduces oreliminates the need for multiple tries at electrode array placement toidentify the directions of anisotropy.

Additional benefits and uses of OTI measurements include but are notlimited to:

-   -   1. The transfer impedance amplitude of OTI measurements on        anisotropic materials is theoretically zero and practically very        small when a direction of CTI is aligned is the direction of        anisotropy. By an anisotropic material, we mean a material with        a (complex) conductivity tensor that is not the identity matrix.        Practically, a material where the CTI depends on the orientation        of the electrodes with respect to the material.    -   2. As a result, OTI measurements can use this “null” to confirm        that the electrodes are aligned.    -   3. When OTI electrodes are rotated with respect to the material,        the transfer impedance phase displays sharp 180° transitions as        direction of CTI in the electrode array becomes collinear with        the directions of anisotropy. This sharp transition can be used        to determine how closely aligned the electrode array is with the        material under test.    -   4. If the voltage sensor electrodes are equidistant from each of        the drive electrodes capacitive coupling between the drive and        sensor electrodes is approximately eliminated when the        difference between the two voltage sensor electrodes is taken.        This results in more accurate measurements, particularly at        higher frequencies where capacitive coupling can be substantial.    -   5. By the symmetry of the topology, any capacitive coupling        between the drive and sensory electrodes is eliminated when the        difference between the pairs of sensory electrodes is taken.        This can improve the accuracy of the measurement by eliminating        parasitics due to capacitive coupling. These parasitics become        pronounced at higher frequencies.    -   6. By orthogonality, there is no magnetic flux from the drive        and sink electrodes to the sensory loop, though there may be        magnetic flux still due to the current in the material if the        current does not flow symmetrically between the drive        electrodes. This can improve the signal-to-noise ratio of the        measurement by reducing parasitics due to magnetic flux in the        measurement loop. These parasitics become pronounced at higher        frequencies.    -   7. It is not required that the electrodes be aligned with the        principal directions of anisotropy of the test material. If, for        example, the material is anisotropic and has diagonal        conductivity and permittivity tensors (“diagonally anisotropic”)        and the drive electrodes are placed so that they are not aligned        with any principle direction of anisotropy, the device will        yield non-zero differential measurement between each pair of        sensory electrodes at nearly all frequencies. This can eliminate        the need for identifying the direction of anisotropy prior to        measurement and simplifies and accelerates the measurements.    -   8. If the material is diagonally anisotropic, and if the drive        electrodes are 45-degrees with respect to the closest direction        of the anisotropy, the differential measurements are maximized        in magnitude. One embodiment of OTL achieves its best        signal-to-noise ratio in this configuration.    -   9. By using two or more sets of sense electrodes, there is the        possibility of determining the complex conductivity of the        material. When only one set is used, the complex conductivity        cannot be determined in general. For example, in the DC case,        the ratios of the conductivities and the magnitudes of the        conductivities in the principle directions will impact the        measurement, and they can be individually manipulated to yield        the same differential measurement across a single differential        pair of sense electrodes    -   10. If the material is (a) isotropic or (b) diagonally        anisotropic with the drive electrodes aligned with a principle        direction of anisotropy, the differential measurements yield a        (nearly) zero measurement if the material's boundaries are        sufficiently far away. Thus, the topology can be used easily to        detect isotropic materials or alignment on diagonally        anisotropic materials.    -   11. The topology offers a different parameterization for        transfer impedance of anisotropic materials (such as muscle)        that may be better correlated to the detection of evaluation of        internal properties of the measured material than collinear        measurements.

Because the field of bioimpedance has been focused largely onmeasurements of isotropic surfaces or measurements along principledirections of anisotropy, OTI measurements would have yielded zero (ornearly zero) measurements and, thus, been discarded. However, OTI canyield useful measurements of anisotropic materials and yield directmeasurements of on/off angle measurements. To illustrate the benefits ofthe orthogonal topology, consider FIG. 15 of the impedance of a piece ofmeat using the orthogonal topology. The meat was measured both with andwithout a isotropic surface (TX-151) over it.

The left plot of FIG. 15, measurements are taken at various angles atapproximately 50 kHz. At approximately 0°, the measurement is minimized(nearly zero). At approximately 45° and approximately 135° with respectto either principle direction of anisotropy of the meat (the twoprinciple directions are approximately 90° apart, meaning it isdiagonally anisotropic), the measurement is maximized. In between, themeasurement is between these two extremes. On the right plot of FIG. 15,measurements were taken at various frequency at approximately 45°. Notethat the isotropic TX-151 yields a nearly-zero measurement while meatand meat with a layer of TX-151 yield a non-zero measurements.

Additional OTI Electrode Array Configurations

As noted above, the disclosure embodies not just the physical layout ofthe electrodes but also the electrical connections and usage of theelectrode array to conduct CTI and OTI measurements at multiple angleswith a single placement of the electrode array on the MUT. Not intendingto be limiting, there are several other electrode array geometries whichcan be used for OTI measurements: FIG. 16, for example, shows two-pairOTI measurement, where one differential pair consists of inner two senseelectrodes and the other differential pair consists on outer two senseelectrodes. In another example, shows an array with sense electrodesoff-center. Further, FIG. 18 shows use of only one pair of senseelectrodes. However, any number and any suitable configurations of senseelectrodes may be used within the principles of the present disclosure.

In some embodiments, the orthogonal measurement may be made withoutmeasuring a differential orthogonal to the drive electrode pair. FIGS.19 and 20, for example, illustrate this concept. In FIG. 19, forexample, a third electrode may be used as a common differential pointfor the measurement. In this case, the orthogonal differentialmeasurement, denoted as E₂−E₁, can be obtained from measurements ofE₃−E₁ and E₃−E₁ as E₂−E₁=(E₃−E₁)−(E₃−E₂). This yields the samemeasurement benefits of topologies discussed previously. FIG. 20 issimilar.

FIGS. 21 and 22 illustrate a combination of a standard (collinear)tetrapolar electrode topology, where sensory electrodes are collinearwith respect to the drive electrodes, and an orthogonal electrodetopology. The combination allows for use of both electrode topologieswith a single electrode head, allowing for non-zero measurements of bothisotropic and anisotropic materials with a single compact electrodeinterface. In FIG. 21, for example, a single dedicated pair of driveelectrodes may be associated with a pair of collinear electrodes and apair of orthogonal electrodes. In general, a single drive pair can bededicated with several sets of electrode pairs in either configuration.In FIG. 22, outer electrodes 220 may be used as both drive and sensoryelectrodes. As sensory electrodes, they act as another pair oforthogonal sensory electrodes. As a drive pair, they can be take ancollinear measurement with the other sensory electrodes 230.

FIG. 23 illustrates revolutions of the electrode topologies. In general,this revolution can take place over any number of discrete angles.Rotating regularly over a fixed number of degrees until approximately360° is obtained yields a topology over which both collinear andorthogonal measurements can be taken over many angles. Generally, anyelectrode configuration can be revolved to produce a revolved topology.The revolved topology has the advantage of producing measurements overmany different angles, which can improve the characterization of thematerial by providing measurements can be fit with curves and,therefore, regressed. Any number of outer and inner rings may exist.

Turning now to FIG. 24, there is a configuration partially obtained byrevolutions. There is an outer ring of drive electrodes and an innerring of electrodes produced by revolutions. There are also two pairs ofelectrodes within the inner ring. In this setup, many collinearmeasurements can be taken over each angle, many single-pair orthogonalmeasurement can be taken over each angle, and a two two-pair orthogonalmeasurement is taken at one angle. In this setup, the two innerorthogonal measurements can be taken at 45° for maximum signal while theremaining angles provide points for angular regression. It is possibleto add any number of additional electrodes to, or reduce the number ofelectrodes from, this setup to provide additional orthogonal orcollinear measurements

Multiple sets of rings can be used with different revolution angles canbe used. It is also possible to space the electrodes irregularly or toplace the tetrapolar sets of electrodes asymmetrically with respect toother tetrapolar sets.

Electrode Contact Verification

When making LBTI measurements, it is important to minimize contactimpedance between the electrodes (element 101 of FIG. 1 and element 101of FIG. 2) and the tissue. Large contact impedances may result inmeasurement errors. The disclosure in this section is a method forverifying proper contact between electrodes and tissue and notifying theuser whether all or a predetermined number of electrodes in an electrodearray are making contact with tissue or not speeding up measurement timeand reducing the likelihood of unsatisfactory measurements.

In one embodiment of the disclosure, an LBTI system like the one in FIG.1 is used in which the electrical signal applied to the tissue may besourced using a voltage signal. The resulting current that is sunk andmeasured using a transimpedance amplifier is a function of the tissueimpedance and the contact impedance. FIG. 26 illustrates a section of asimplified LBTI system and along with a variety of impedances. In suchan embodiment, a voltage signal V is supplied and a current I_(M) ismeasured using a transimpedance amplifier. The voltage V_(M) measuredusing an instrumentation amplifier is approximately equal to the productof I_(M) and Z_(T), where Z_(T) is the tissue impedance being measured.As a result, an accurate measurement of the transfer impedanceZ_(M)=V_(M)/I_(M) can be made if accurate measurements of I_(M) andV_(M) are made.

Current I_(M) is a function of V, and the sum of Z_(S), Z_(CT), Z_(T),Z_(CB), and Z_(TIA). A properly designed transimpedance amplifier has aninput impedance Z_(TIA) that is much smaller than the other fourimpedances mentioned. An impedance value of 1000 Ohms or more can beused for Zs to limit the maximum current supplied to the patient.Impedances Z_(CT) and Z_(CB) represent the contact impedances of thesignal source electrode and current sense electrode. Ideally, these arerelatively small compared to the tissue impedance Z_(T). However, inreality, these can be relatively larger than Z_(T) and therefore resultin the current I_(M) being smaller than desired. Depending on theelectrode material, size, and other factors, the contact impedance maybe larger than some threshold and result in poor measurement quality. Toavoid such scenarios, it would be useful to inform a user whether theelectrodes are making sufficiently good contact before a fullmeasurement is made.

For LBTI systems in which multiple electrode configurations are used, itis also important to inform the user which electrodes are making goodcontact and which are making poor or no contact. This should be done in“real time” with minimal delay between changes in the contact impedanceand the alert to the user.

In one embodiment of the disclosure, the process of determining whichelectrodes are making good contact and notifying the user may includeone or more of the following steps:

-   -   1. One of multiple electrode configurations is selected. For        example, S1 is selected as the signal source electrode, VP1 and        VM1 are selected to measure the differential voltage, and I1 is        selected to sink and measure the current.    -   2. A signal is applied to the tissue and the resulting voltage        and current are measured.    -   3. The amplitude of measured voltage and current are compared        against a predefined range.    -   4. If the current is within the desired range, a figure is shown        to the user through a graphical user interface (GUI) with        electrodes S1 and I1 in a particular color (green, for example).    -   5. If the voltage is within the desired range, a figure is shown        to the user through a graphical user interface with electrodes        VP1 and VM1 in a particular color (green, for example).    -   6. If the current or voltage are outside of a desired range, the        respective electrodes are shown in a different color (red, for        example).    -   7. A different configuration is selected, and steps 1-6 are        repeated. For example, S3 might be selected as the signal source        electrode, VP3 and VM3 selected to measure the differential        voltage, and I3 selected to sink and measure the current. The        procedure might be repeated until all electrodes have been        measured in all configurations.    -   8. If desired, a computer can monitor the several measured        current and voltages, determine if they are in the desired        ranges and signal the in-range or out-of-range performance by        visual, audio or combination signal.    -   9. If any electrode is not making proper contact, the user can        adjust the electrodes while getting feedback from the GUI to        verify if the contact is now appropriate.    -   10. Once all of the electrodes are making good contact, the user        can initiate a full measurement by pressing a button or through        some other means. Alternatively, a computer can automatically        determine that proper contact is being made and initiate the        measurement.    -   11. If the user chooses to perform the full measurement despite        poor contact by some electrodes, the system can allow the user,        but it can issue a warning after the measurement that the data        may contain error due to improper contact.    -   12. Further, if the data is being stored for future analysis,        the data files may contain a note stating that improper contact        was being made by a particular set of electrodes.

FIG. 27 shows an example of a display that communicated whether one ormore of the electrodes are making good contact and others making poor orcontact. On the left, many electrodes are making poor contact. Afteradjusting the electrodes, the user is informed that more electrodes aremaking good contact, but some are still not making good contact(middle). Finally, after further adjustment, all electrodes are makinggood contact and the user can see this because all electrodes may berepresented by, e.g., a green color (right). In addition to visualdisplays, any suitable means for communicating electrode contact statusmay be used within the principles of the present disclosure. In someinstances, the devices disclosed herein may emit an audible sound forcommunicating contact status to a user.

Verification, Validation and Calibration

The measurement of anisotropic materials is an application for EIM.Verifying that the measurement system is operating properly can be partof design, development, qualification and calibration of EIM devices.This may require a material to be tested with known and quantifiedanisotropic properties.

This disclosure involves using regularly connected “impedance cells” ofdiscrete components such as, e.g., resistors, capacitors, and possiblyinductors in a mesh to verify, validate, and/or calibrate an impedancemeasuring device. The mesh may be an emulation of a continuousanisotropic material such as muscle tissue. Although only a2-dimensional mesh (in general different X-axis and Y-axis impedancecells) is shown in FIG. 28, three-dimensional meshes, which includedepth, are possible.

FIG. 29 illustrates how one may connect a unit under test (UUT), whichin general is any electrical measuring device, to the impedance mesh. Inthis particular illustration, AC is current driving, TIA is currentmeasuring, and IA is voltage measuring.

FIG. 30 illustrates one embodiment of connection of the edges of theimpedance mesh in what is known as a topological torus. This results inimpedance measurements on the mesh that do not depend on the absoluteplacement, but rather only on the relative placements of the electrodes.

FIGS. 31 and 32 illustrate the use of a Simulation Program withIntegrated Circuit Emphasis (SPICE) circuit simulator for the purposesof determining the electrical behavior of a mesh with a particular setof component values. Anisotropic material emulation can serve variouspurposes, including, but not limited to, one or more of the following:

-   -   1. Verification and validation: The process of checking that a        product, service, or system meets specifications and that it        fulfills its intended purpose. These are critical components of        a quality management system such as ISO 9000 or ISO 13485.    -   2. Verification: Quality control process that is used to        evaluate whether or not a product, service, or system complies        with regulations, specifications, or conditions imposed at the        start of a development phase. Verification can be in        development, scale-up, or production. This is often an internal        process.    -   3. Validation: Quality assurance process of establishing        evidence that provides a high degree of assurance that a        product, service, or system accomplishes its intended        requirements. This often involves acceptance of fitness for        purpose with end users and other product stakeholders.    -   4. Calibration: Comparison between measurements—one of known        magnitude or correctness made or set with one device and another        measurement made in as similar a way as possible with a second        device.    -   5. The device with the known or assigned correctness is called        the standard. The second device is the unit under test (UUT),        test instrument (TI), or any of several other names for the        device being calibrated.        Not intending to be limiting, in one particular implementation:    -   The nominal standard behavior is derived from running an LTSpice        AC analysis simulation for FTI of four chosen electrode contact        points. The output of LTSpice analysis is a plot and data for        the transfer function of this four-port transfer impedance.    -   The effect of component tolerances (time, temperature, batch,        etc.) results in a distribution of transfer function curves.        This distribution of curves can be derived by running many        simulations over random distributions that are specified for        each component—sometimes this is called “Monte Carlo simulation”        in the industry. Also from [Wikipedia 2011]: “ . . . it is        common to use SPICE to perform Monte Carlo simulations of the        effect of component variations on performance, a task which is        impractical using calculations by hand for a circuit of any        appreciable complexity.” This results in tolerance        specifications for the standard anisotropic emulator.        The anisotropic emulator can be used in an example verification        process illustrated in FIG. 33.

Electrode Interfaces

The electrode interface may be the physical mechanism that houses theelectrodes and provides a physical connection (electrical andmechanical) to the main system. Two types of interfaces are possible:conformable and non-conformable.

Conformable Material Interfaces

A conformable electrode interface may include, but is not limited to, anelectrode interface that can conform to contours of, e.g., a patient'sskin. Not intending to be limiting, several example conformableinterfaces are discussed below. Not intending to be limiting for otherpossible interfaces, common to all interfaces listed below are one ormore of the following attributes:

-   -   1. The electrodes may be hosted in a patch that can be any        material that is able to stretch and/or flex and/or fold and/or        conform. Mylar is an example material. Another example is        polyethylene terephthalate (PET).    -   2. The entire patch may be single- or multi-layer, with at least        one layer dedicated to holding the electrodes and tunneling        wires to conduct an electrical signal. A multi-layer patch will        have one layer dedicated to hold electrodes, and other layers        dedicated to carrying signal and may be separated by a        dielectric to facilitate better signal routing along with the        possible inclusion of guard layers to reduce parasitic coupling        between drive and sense signals.    -   3. The electrodes of the patch can be any conductive material        (such as Ag/AgCl) or adhesive, or any deformation (such as a        “bump”) in the patch itself. In the latter case, cold- or        thermo-forming may be used to shape the patch. The electrodes        may have any shape, including half-spheres, which may offer some        contact benefits over flat electrodes.    -   4. Either a tab, a wired interface (such as a male/female        connector), or contacts on the patch itself electrically connect        the electrodes of the patch with the system.    -   5. The electrodes themselves are arranged according to any        topology, including the ones discussed previously.

FIG. 34 is an illustration of a conformable electrode path that isattached to two holding arms that support the path at its ends.

FIGS. 35a-f are illustrations of two additional embodiments ofconformable electrodes. FIGS. 35a and 35b show these electrodes andFIGS. 35c through 35f give additional details about the electrodes shownin FIG. 35b . There are several advantages to these designs:

-   -   1. They can conform around cylinders, which approximates the        geometry of various measurement sites of interest on a human        body, including arms, legs, and forehead, where fixed, flat        electrode interfaces cannot be applied.    -   2. They can be quickly applied and removed from a measurement        site, unlike the individual strip electrode used on existing        bioimpedance devices such as the ImpediMed SBF7 and the        ImpediMed DF50.    -   3. Different patches can contain differently-sized electrode        arrays with potentially different layouts that are customized        for different measurement sites.    -   4. The patches can be quickly attached and removed from the        system.    -   5. The patch may be disposable to simplify any possible        sterilization requirements.

In the holding arm design, the holding arms may or may not move orrotate. One method for rotation is a set of hinges at the top of thearms with possible stops to stop them from rotating too far. If they arehinged, they can pivot inward as the patch is pressed inward toward thedevice, allowing for better conformability. If the holding arms arehinged, a (possibly low-force/torsion) spring may be used provideoutward force on the holding arms to keep the patch taught as it isbeing pressed onto the measurement surface.

The single-mold design does not require a spring because the materialitself performs this function. In the holding arm design, the connectorhas a set of contacts on the patch that come into contact with contactson the holding arms, but it is not limited to this type of connector.

FIG. 36 is an example of a flat, flexible patch 36010. The patch 36010may be coated with non-conducting medical grade adhesive innon-electrode areas to ensure the electrodes to make good contact with,for example, skin, even as the area changes due to, for example, musclecontraction.

FIGS. 37 and 38 are examples of curved, flexible patches 37010 and38030. The patches may be coated with non-conducting medical gradeadhesive in non-electrode areas to ensure the electrodes 38040 make goodcontact with the skin. The patch 37010 in FIG. 37 can be made curved bythermoforming or cold-forming. If the patch is composed of multiplelayers, some of those layers can provide curvature, and the remaininglayers would be adhered to it. The patch 38030 in FIG. 38 uses a backing38010, such as silicon-foam, with electrical contacts 38020 to at leastprovide curvature and to also possibly provide some resistance topressure. The advantage of these patches is that they may not depend onadhesives or the apparatus to conform to a curved surface sincecurvature is achieved by back layer that generate an internal inwardforce.

FIG. 39 illustrates possible electrical contact backing for the designsfor the flexible patches 37010 and 38030 of FIGS. 37 and 38. Thefront-side 39050 of the flexible patch includes electrodes 39040, andthe back-side 39010 includes conductive traces 39020 that connectcontacts 39030 to through-hole vias 39060 that connect the traces 39020to the electrodes 39040. The electrical contacts 38020 in backing 38010(see FIG. 38) provide an electrical connection from the electrodes 38040to the main system electronics.

Conformable Actuator Interfaces

Non-conformable electrode interfaces with the ability to rotate oradjust electrode positioning have the advantage of being able to takemeasurements over many angles, electrode spacings, and electrode layoutsby providing convenient or automatic adjustment of several electrodes.This is advantageous in settings where fine-resolution angularmeasurements and a high-precision force-to-displacement curve aredesired. Furthermore, by using fewer electrodes, measurement errors dueto electro-magnetic parasitics are reduced relative to a design wheremany more electrodes are used to obtain fine angular resolution.

FIG. 40 is an illustration of such an interface, and FIG. 41 is anillustration of an electrode from the interface. Electrode ends areshown as spheres in the diagrams, but they can be a half-sphere or anythree-dimensional volume (including nearly flat shapes). Electrodes maybe rigid or may provide active or passive actuation with constant orvariable force. In the constant-force case, forces of the electrodes onthe surface are constant for each electrode. In the variable-force case,force can vary due to applied pressure from the user or due to thedevice itself, which may modulate force on the electrodes. Electrodesactuation is independent of the actuation of other electrodes, or it candepend on them; for example, if forces were to be modulated in aparticular order. The electrodes may also be attached to a surface thatcan revolve independently of entire measurement apparatus.

We also designed and constructed a magnetic linear actuator. Unlike aspring, the linear actuator provides constant force through thespecified displacement range proportional to the current applied.

Rigid and Actuated Support

Any rigid attachment (via permanent adhesives, soldering of metalliccontacts, screws, etc.) may be used to attach any of the electrodeinterfaces to the system. A non-permanent attachment also may be usedwhereby the electrode interface is easily removed and attached, asdesired. Any of the electrode interfaces can attach via this method. Theinterface may also permanently or temporarily attach to a fixed orrotating surface that can be used to rotate the electrode interface andprovide measurements at various angles. An advantage of anynon-permanent attachment is that the patch can be replaced more easily.

The attachment may also provide variable or constant force to improveconsistency of force of the electrodes on the measurement surface. Inthe constant-force case, forces of the electrodes on the surface areconstant. In the variable-force case, the force can vary due to appliedpressure from the user or due to the device itself, which may modulatethe force on the electrodes.

To drive an active actuator, a closed-loop constant current driver canquickly retract or apply constant force with the electrode. The actuatorhas high-field, cylindrical permanent magnets (such as NdFeB) along theaxis connected to a shaft that carries the spherical electrodes. Theshaft moves axially inside two counter-wound magnetic coils, encased ina high permeability, low carbon steel barrel to increase force byclosing the magnetic circuit. The shaft slides in a low-friction, Delrinbushing.

An example of the “constant-force” actuator may be a dual coil, movingmagnet design (FIG. 42). The windings are driven by a constant currentsource shown in FIG. 44 with response time less than approximately 100ms. Magnetic steel tubes and magnetic steel endpieces result in a closedmagnetic circuit. Fringing magnetic fields at the ends are actually whatcreate the electromagnetic force. The electromagnetic actuator allowsthe study of the effects of tissue pressure on the impedance measurementby allowing the force, which is proportional to current to becontinuously varied.

FIG. 43 shows an example block diagram of actuators digitally controlledby an FPGA and a DAC. FIG. 44 shows an example of a linear poweramplifier with current output commanded by a voltage input from the DAC.The 10-bit DAC output voltage range is from 0 to 5 Volts. R1, R2, R3, R4and Vbias are selected so 0V from the DAC corresponds to −2 Amps and 5Volts corresponds to 2 Amps, and 2.5 V to 0 Amps.

FIG. 45 is an example of a passive spring actuation support system. Oneor more mainsprings may connect to the top of the actuator to extend itwith constant force. The actuator may move through a linear bearing toprevent side motion and provide low friction. Both configurationsprovide constant force. Variable force is achieved using springs ormaterials that have a non-constant force-to-displacement curve, such asa coil spring or foam.

FIG. 46 is an example of a patch connected to the system via aninterface board. In this example, the electronics subsystem may bepartitioned so that part of the subsystem is permanently attached to theapparatus, and the remaining portions, an interface board, attaches tothe patch itself to interface with the electrodes. The electrodeinterface connects to the interface board, and a wire may connect theinterface board to the remainder of the electronics subsystem, namely,the signal processing board, or it may be wireless.

Additional Features and Improvements

Automatic Verification of Good Electrode Contact

As mentioned above, one type of embodiment of disclosure uses a multiplecontact electrode assembly. Such an embodiment contemplates utilizingfour contacts, two to generate current and two to measure voltage. Someembodiments of the disclosure use an electrode assembly with a largenumber of contract electrodes. Other embodiments may use a lesser numberof contacts. This can enable anisotropic measurements to be made in aplurality of directions with a single placement of the electrodeassembly by the practitioner. In one type of embodiment of thisdisclosure, each electrode in the electrode assembly makes full skincontact, resulting in sufficiently low contact impedance, particularlysince it is beneficial to avoid use of ionic gel for convenience andcleanliness reasons.

In another type of embodiment, the contact impedance may be particularlylow for drive electrodes. Two-port impedance between drive electrodes isa combination of tissue impedance, which is the objective of themeasurement, and contact impedance between each electrode and skin.Although FTI measurements are made precisely to minimize effect ofcontact impedance on accuracy of measurement, having a high contactimpedance can still degrade measurement to some extent. To get accurateresults, contact impedance should be at most ten time as large as tissueimpedance being measured.

Further, a feature can be present to verify that all electrodes in anelectrode array are making good contact. The system can either verifyautomatically that contact is good or provide information to the userconcerning quality of contact of each electrode.

For example, a graphical user interface (GUI) can contain a graphical orcolumnar representation of the electrode array. In one type ofembodiment, after positioning the electrode array and prior to makingmeasurements, the system makes measurements to verify good contact. If aparticular electrode is making good contact, it can be displayed asgreen on the representation or with a plus (+) sign or other positivesign. Any suitable indicator may also be used. If an electrode is notmaking good contact, the display can be red or with a minus (−) sign orother negative sign. Again, any suitable indicator may be used. The usercan then reposition the electrode assembly to achieve good contact forall electrodes.

With one type of embodiment of automatic verification, the systemassesses all electrodes simultaneously, or in succession. Theinformation is presented to the user either as positive, meaning thatall contacts are good or non-positive meaning that one or more contactsare not good and the electrode assembly needs to be repositioned.

Without intending to be limiting, one method that is used to verifycontact may include one or more of the following steps: The contact tothe drive electrodes can be verified by measuring current resulting fromapplying a voltage to this electrode. If resulting current is within anacceptable range, then drive electrodes are considered to have goodcontact. Alternatively, a current can be driven through the electrodesand if resulting voltage at the electrodes is within an acceptablerange, then good contact is similarly considered. Any combination ofcurrents and voltages may be used and what is essentially two pointresistance between two electrodes characterize whether contact isacceptable. The voltages or currents may be DC or AC.

Contact to sense electrodes may also be similarly measured as above withthe drive electrodes. Alternatively, DC or AC voltage may be applied tothe drive electrodes and current measured and voltages on a pair ofsense electrodes measured. The FTI characterizes whether contact isacceptable. Also, instead of a voltage applied to the drive electrodes,a current source can directly be used. Measurement can occur quickly andrepetitively and in one type of embodiment, visual and/or audio means isused to inform the user of electrode contact status before a measurementis made. Low frequencies (of approximately 1-10 kHz) may accentuate theeffect of contact impedance on the overall measurement, but higherfrequencies may be used as well.

The indicator for electrode contact can be one that communicates theelectrode status all at once, or it may communicate which electrodeshave good contact and which have poor contact.

Using the EIM1103 device which is an embodiment of the disclosuredesigned and built according to FIGS. 1, 2, 3, 9, 10, 11, 12, and 57,more than 20 human subjects have been tested and the contact impedanceof the electrodes have been automatically verified in each case usingthe disclosure described. Testing of proper contact was conducted foreach subject.

The EIM1103 includes primarily a handheld EIM device, a conformableelectrode array, and a computer. The computer has software with agraphical user interface. When conducting an EIM test, the computerdisplays an image that resembles the electrode array. Immediately beforeconducting a test, saline, or any other suitable substance, may beapplied to the skin of the subject to minimize the contact impedance.

With the EIM 1103, a button on the computer was then pressed to initiatethe test. Each test has three parts: 1) good contact verification, 2)multi-frequency and multi-angle EIM sweep, and 3) data display. In thefirst part, an approximately 50 kHz sinusoidal voltage signal with knownamplitude (approximately 10 mV peak-to-peak) was applied using the driveelectrodes for approximately 100 ms and resulting current was measuredat the drive electrodes. Simultaneously, the voltage signal was measuredon the voltage-sensing electrodes. After, e.g., each 100 ms sweep, themeasured current and voltage amplitudes were compared by the computer topreset thresholds (e.g., 5 uA for current and 1 mV for voltage). Ifmeasured current was below the threshold, the drive electrodes may bedisplayed in red on the PC.

Likewise, if measured voltage was below the threshold, thevoltage-sensing electrodes were displayed in red. If measured currentwas above the threshold, the drive electrodes may be displayed in greenon the PC. Likewise, if measured voltage was above the threshold, thevoltage-sensing electrodes may be displayed in green. This process wasrepeated approximately every 200 ms and image on the computer updated,so that when electrodes were making good contact, the user would confirmwith green images.

In each case, electrode images on the computer were red prior to contactwhen electrodes were not making contact with the subject. When the userwas ready, the electrode array was pressed against the subject's skin.If good contact was made, computer images turned green. At that point,the user either pressed a button on the handheld device, or on thecomputer to initiate the second part of the measurement (multi-frequencyand multi-angle measurement).

Constant Force Electrode Assembly

The force applied by electrode assembly to the user's skin variesdepending upon the skill and strength of the operator and can varysubstantially. It is useful and beneficial to have a “constant force”actuator which arranges that a relatively constant force is applied bythe electrode assembly to the user's skin regardless of how tightly theoperator presses the electrode assembly to the skin of the user.

Without intending to be limiting, one method to achieve a constant forceapplicator is a magnetic linear actuator. Unlike a spring, the linearactuator provides a constant force through the specified displacementrange. The force is only proportional to current applied. To drive theactuator, a closed-loop constant current driver with a sufficiently fastresponse time (for example, 1 ms) can be used to quickly retract orapply a constant force with the electrode.

In one embodiment of the disclosure, the actuator may includehigh-field, cylindrical (NdFeB permanent) magnets along the axis whichare connected to a shaft attached to the electrodes. The shaft movesaxially inside, e.g., two counter-wound magnetic coils, encased in ahigh permeability, low carbon steel barrel to increase force by closingthe magnetic circuit. The shaft slides in a low-friction, Delrin bushingimpregnated with molybdenum disulfide.

In another embodiment, the design uses passive actuation. The rail ofthe linear guide is attached to a machined base that is then covered bya housing composed of a material such as acrylonitrile butadiene styreneor a similar material such as Somos® NeXt that attaches to the base ofthe device with the electronics. The carriage of the linear guide hasone or more spools mounted to it that contain stainless steel extensionsprings that are approximately 0.007 inch thick with an outside diameterof approximately ¾-inch. The loose end of the spring attaches to themachined base, and the handle is attached to the carriage.Constant-force follows from the fact that the extension springs provideconstant force.

FIG. 47 is device with a portion of the housing cut away to show theinner parts.

Conformable Electrode Assembly

Although typically electrodes are flat or preshaped into some specificnon-flat shape, some of the body extremities which we measure are notflat nor non-flat in any simple geometry. It is useful and beneficial tohave an electrode assembly and electrode device which can conform to theshape of the body extremity or body part so that the multiple contactpoints of the electrode assembly are all in intimate contact with theskin.

Another element of the disclosure includes a rectangular sleeve typeelectrode assembly which is conformable and provides excellent multiplepoint contact on irregular skin surfaces. Without intending to belimiting, in one embodiment, the rectangular sleeve is rubber about 50mils thick, and about 4 inches in height and 4 inches in diameter. Theelectrodes are present on the outside of the sleeve with the maximumspacing between electrode contacts being about 90 degrees of arc of thecylinder or about 3 inches. The hollow sleeve is applied to the skin sothat the electrode contacts are pressed against the skin. Theelectrode-side will match the contour of the surface, and the side wallsof the patch will bend to accommodate this temporary deforming of therectangular sleeve. The plurality of contacts is thus pressed intosatisfactory contact with the skin with sufficient force to give goodcontact but not so much that it is uncomfortable for the person beingmeasured.

In one embodiment, the rectangular sleeve may be constructed from asingle mold, and the electrodes may be applied via a flexible backing (a“patch”) that is either adhered to the sleeve and/or wrapped around thesleeve. The patch can be any material that is able to flex/bend withoutbreaking, such as Mylar or polyethylene terephthalate or polyimide. Thepatch may be wrapped around the walls of the sleeve to form electricalconnections from the electrodes to the electrical contacts atop theassembly. The top of the sleeve opposite the electrodes may be adheredto a solid surface having electrical and mechanical contacts with whichit can connect to the measurement system. There recently has also beeninformation published about very thin patch electrodes described as“temporary tattoo electrodes.” See, for example,http://topnews360.tmcnet.com/topics/associated-press/articles/2011/08/14/207909-stick-on-patch-proposed-patient-monitoring.htm,Aug. 25, 2011, which is incorporated herein in its entirety byreference. The use of this type of electrode device is also contemplatedwith our disclosure.

Graphical User Interface (GUI) which Assists Operation in CorrectOperation

In one type of embodiment of our disclosure, there is verification thatthe steps of operation are all correctly carried out in the right order.For verification of research protocols and/or patient care protocols, itcan be useful to document and verify that all of these steps have beencarried out in the right order. In one type of embodiment of ourdisclosure, the GUI can indicate to the operator what are the correctsteps of device usage, verify that the step has been correctly carriedout, document and store in an electronic and/or paper file that the stephas been correctly carried out including logging date, time, operatorand patient (either by name or by code designation), indicate to theoperator if the step is not correctly carried out and, when the step iscorrectly carried out, then indicate the next step to be performed.

Without intending to be limiting, a suitable measurement, in accordancewith the principles of the present disclosure, may be taken by followingone or more of the following steps:

-   -   1) Identify that the correct practitioner is operating the        device.    -   2) Verify the correct identity of the patient. This could, for        example, be a patient number for a non-research patient or coded        patient identify for a blinded study. In the latter case, some        additional identification could be provided to ensure correct        patient identification while still remaining blinded.    -   3) Present the test to be made and verify that is the correct        test    -   4) Show (and possibly verify that) the correct electrode        assembly that is to be used and possibly determine that the        electrode device is appropriate and approved for use. For        verification, the software can either have the device obtain an        electronic code stored in the electrode assembly to verify that        it is correct or have the practitioner enter a code printed on        or otherwise supplied with the electrode assembly into the        device.    -   5) Instruct the practitioner on the correct placement of the        electrode assembly for this specific test.    -   6) Have the practitioner verify that the electrode assembly is        correctly placed.    -   7) Automatically verify that good contact has been made by all        electrodes in the electrode assembly to the skin of the patient        at the specified measurement site.    -   8) Automatically perform the test OR instruct the practitioner        to start the test.    -   9) Perform the test (this requires no action on the part of the        practitioner).    -   10) Verify that the data collection appears to be reasonable        based on what is expected i.e. that electrode contact has        remained good, etc.    -   11) If desired, verify that the data collected is reasonable        based on historical measurements and on expectations i.e. that        the data is in line with past measurements, measurements within        the same session corresponding to the same or different        measurement sites, on other patients, or on the same patient.        Use error vector measurements to make these judgments.    -   12) If the data collection and/or data collected is not        reasonable, re-perform test from step 4 or later.    -   13) If the data collection and data collected is reasonable,        move on to the next test to be performed. If all tests are        completed, instruct the practitioner that they are finished.    -   14) If multiple performances of the same test are desired,        inform the practitioner of each in turn and verify that each        test is reasonable when compared with data as discussed in step        11.

Detachable Multi-Part Electrode Assembly

Another element of our disclosure includes a selectively detachablemulti-part electrode assembly. In one type of embodiment of ourdisclosure, the electrode assembly contains at least two parts, theelectrode device which contains electrodes that make skin contact andthe connections between electrodes and the measurement system, which canbe a wired connections, a wireless connection, a multiplexed connection,some combination of these techniques, or other methods to transmit theelectrical signal from the electrodes to the electronics. An embodimentof our disclosure has an electrode assembly in which these two parts areseparate and separable. In other embodiments, they may be integral. Theelectrode device can, for example, be disposable and intended for singleuse by the patient. In such embodiments, the electrical connectionswould be intended for multiple use, however. An example of a method forreliable contact is metallic male/female contacts which mate with eachother or contacts which are flat or otherwise shaped and provideintimate ohmic contact can be used. For electrical contacts which do notprovide a mechanism for physically (mechanically) connecting theelectrode device and measurement apparatus, a separate mechanicalconnection can be used. If a separate mechanical connection is applied,an embodiment of our disclosure has these two parts detachable andeasily assembled and disassembled by the practitioner while reliablybeing held together during use. Without intending to be limiting, onemethod of effecting this holding together can be magnets present in theelectrical connection assembly, in the detachable electrode device orboth. The magnets and/or posts and sockets or other parts of the devicecan be arranged in a pattern that guarantees that the electrode devicecan only be attached in a single (correct) orientation. Another methodcan be a precision press fit or snap fit of plastic or metal parts.

Verification that the Electrode Device is Proper and Approved for Use

In another element of our disclosure, there is verification that in themulti-part electrode assembly that the electrode device has beenproperly chosen and qualified and is approved for the intended use. Inanother element of our disclosure, there is determination if anunapproved or counterfeit electrode device is attached in the electrodeassembly so that the EIM electronics can notify the practitioner of theunapproved electrode device and/or cause the EIM electronics to fail tooperate and take data using the unapproved electrode device.

Without intending to be limiting, an exemplary method for creating thisobjective may include creating a circuit in the electrode device, a chipwith a preset serial number, or other identifying designator. As part ofthe pretesting routine, the EIM electronics reads the identifier on thischip and verifies that the electrode device is authorized. Withoutintending to be limiting, methods to accomplish this verification caninclude, but not limited to, having the library of approved serialnumbers stored on memory in the EIM electronics, having the approvedidentifiers created using a coding scheme which can be verified in theEIM electronics, and having the serial number and/or identifierstransmitted to a central location for remote verification prior toauthorization to proceed with the test.

Another embodiment of the disclosure would have verification of theserial number achieved by access through an online database to which theEIM electronics and computing device is connected. Upon usage, the EIMdevice would check out the serial number from the database for which usecan be only one time. The database enforces this one time use by keepingtrack of serial numbers that are checked-out. This check in and checkout procedure can occur in batches in which batches of serial numbersare checked out, in which case the EIM device ensures one time use.

Verification that the Electrode Device is Used Only a Single Time

Another element of our disclosure has verification that if the electrodedevice is intended as a single use device, it is indeed used only asingle time and the attempt is not made to use it multiple times. thiswill avoid contamination, questionable electrical connections, etc.

There are several methods which can be used to so verify that the deviceis only used a single time. Without intending to be limiting, thesemethods may include one or more of the following steps:

-   -   1) Incorporating into the electrode device circuitry including a        chip which can be written onto by the EIM electronics. When the        test is performed, some message is written onto the chip        preventing additional use. Conversely, some message might be        erased which would prevent additional use.    -   2) Incorporating into the electrode device a fragile part of        plastic, paper or other material designed to break upon        insertion or removal. This part will be essential to performing        the test so that the attempted use of the electrode device not        including this part would be unsuccessful.    -   3) Incorporating into the electrode device a component which        must be exposed to air for the device to operate. This can be        some electronic component or could be a component or label        displaying the serial number. The component has a limited        lifetime exposed to air and changes in some way. Without        intending to be limiting, this can include changing its        electronic function to indicate that the lifetime in air has        been exceeded or else eliminating or changing the serial number        so that it no longer displays an authorized serial number.    -   4) If the remote verification method is used for the electrode        device, as outlined above, storing the identifiers for        electrodes which are authorized for use and denying        authorization for additional use. Alternately, storing the        identifiers of the electrode device which have been authorized        for use and at chosen intervals, having the electronic device be        required to communicate with a central location for verification        of operation. At this time, new electrode devices used in this        and other systems would be removed from the authorized list        while new electrode devices would be added to the authorized        list.    -   5) Another method for one-time use includes using the serial        acquired from the disposable electrode assembly and upon first        measurement, a timer can be electronically or digitally        implemented so that the electrode may only be considered valid        for a fixed amount of time. Alternatively, the electrode can be        limited to a fixed number of measurements.    -   6) Other methods can be used also.

Example 1—EIM Device for Simultaneous Inline and Orthogonal Measurements

We designed and built a configurable platform to automatically measurebioimpedance. The mechanical system used electromechanical actuators forconstant electrode force over displacement, a high angular resolutionstepper motor system to rotate electrodes, and a mounting system foreasy reconfiguration of the electrodes. The electrodes in this prototypeused drilled and tapped brass spheres, which were easy to machine andoffered good chemical resistance to saline.

The electrodes were configured for simultaneous inline and orthogonalmeasurement configurations. However, any other suitable configurationmay be used. The OTI measurement is an element of the disclosure forenhanced sensitivity to changes in anisotropy. This involves driving acurrent into the muscle fiber and measuring the consequent voltagenon-colinearly. In one embodiment of the disclosure, the voltage ismeasured approximately parallel to the driving current. When thisconfiguration of electrodes is aligned either along or across the musclefiber axis, the resulting voltage is zero; however, at 45 degrees, thesignal achieves a maximum and yields transfer impedance data thatrelates directly to anisotropy.

Example 2—Magnetic Linear Actuator

We also designed and constructed a magnetic linear actuator. Unlike aspring, the linear actuator provides a constant force through thespecified displacement range proportional to the current applied. Todrive the actuator, we designed and constructed a closed-loop constantcurrent driver with response time approximately 1 ms to quickly retractor apply constant force with the electrode. The actuator (shown in FIG.48) has high-field, cylindrical NdFeB permanent magnets along the axisconnected to a shaft that carries the spherical electrodes. The shaftmoves axially inside two counter-wound magnetic coils, encased in a highpermeability, low carbon steel barrel to increase the force by closingthe magnetic circuit. The shaft slides in a low-friction, Delrinbushing.

Example 3—EIM Device with Several Additional Embodiments

We designed, constructed, and demonstrated an electronic system withaccuracy, speed, and frequency range that exceed current state of theart for bioimpedance, such as Impedimed's SFB7 used in an ongoingclinical trial. Several additional embodiments of the disclosure wereused to overcome obstacles that typically limit both accuracy andbandwidth in bioimpedance systems. The first embodiment is use of lowimpedance voltage drive and then performing wide bandwidth currentmeasurement at the low impedance sink. By driving tissue at lowimpedance, the effect of stray capacitances, which shunt current andcause errors in commonly used bioimpedance systems, becomes negligible.We overcame the challenge of performing a low-impedance and widebandwidth, yet high accuracy current measurement by using ourproprietary design for a transimpedance amplifier illustrated in FIG.49.

The second embodiment is use of separate low-capacitance, high-bandwidthJFET differential amplifiers for each pair of voltage sensing electrodesto minimize parasitic capacitance. Previous instruments used electronicmultiplexers at the sensing front-end that resulted in increasedparasitic capacitance. By using separate amplifiers, the voltagemeasurement errors from combination of contact impedance and deviceinput capacitance are minimized; these errors include voltageattenuation, as well as common-mode to differential mode voltage errorfrom contact impedance mismatches.

A third embodiment is in the implementation of the lock-in amplifier. Incontrast with typical lock-ins that use analog multipliers, we use highspeed analog-to-digital converter to measure amplified signals directly,and then perform down-conversion and subsequent signal processing fullydigitally. This eliminates the effect of offset voltages, noise anddistortion in comparison to using analog multipliers and filters beforedata conversion. The phase and magnitude errors from the anti-aliasingfilters are minimized by simultaneously measuring voltage and currentsignals from two-channel, device-matched anti-aliasing filters and ADCs.

Example 4—Algorithms for Data Analysis

In one embodiment of the disclosure, we use Cole models for extractingand characterizing the electrophysiological properties of muscle. Colemodels show, among other things, the behavior of electrical impedance ofbiological tissue and are typically used Cole models show the behaviorof electrical impedance of biological tissue and are typically used todescribe the relationship between frequency and complex impedance. Theobtained model is not actual measured data but a curve fitted to theCole equation containing four key parameters (R_(∞), R₀, α, and τ)

$\mspace{20mu} {{Z(\omega)} = {R_{\text{?}} + \frac{R_{\text{?}} - R_{\text{?}}}{1 + \left( {j\; \omega \; \tau} \right)^{\text{?}}}}}$?indicates text missing or illegible when filed

where Z(ω) is complex impedance, R₀ is resistance at zero frequency,R_(∞) is resistance at infinite frequency, τ is the inverse of thecharacteristic frequency of the system, and α is a dimensionlessexponent. The resulting complex impedance generated has a nonlinearrelationship with the independent angular frequency ω and in turngenerates a semi-circle with the imaginary center (negative reactance).

Algorithm Implementation: A challenge in fitting Cole models tobioimpedance data is that standard square-error minimization between themodel and the data is non-convex. This means that we are only guaranteedto find locally optimal parameter values but not necessarily aglobally-optimal value. This in turn implies that either (a) intensivecomputation is required to find (and verify) a globally-optimal solutionwith only some probability of success, or (b) if only locally-optimalvalues are found, the fitted model may not be consistent or not fit thedata well, possibly decreasing the statistical significance of theresulting parameter values. An embodiment of the disclosure involvesfitting Cole models based on two properties of the model: (a) itproduces impedances that lie on a semi-circle (reported in theliterature), and the previously unknown and unexpected phenomenon that(b) three of the four Cole parameters are algebraically related to thatsemi-circle. Using these two properties allows us to reparameterize theproblem into two sequential optimizations guaranteed to have aglobally-optimal solution: (a) a constrained quadratic optimization thatcomputes an optimal circle that fits the data followed by (b) andquasi-convex optimization that uses results of the first step to findthe remaining parameter (which can be solved using any number ofapproaches, including gradient descent). Certain numeric conditioningcan be used to improve accuracy of the results.

Another embodiment of the disclosure involves fitting a Cole model todata that is fit well by semi-ellipses (including ellipses with themajor/minor axes aligned with the coordinate system). In this case, theellipse is transformed into a circle, and the procedure above isrepeated. The center of the ellipse is maintained as the center of thecircle. In this case, properties of the major and minor radii (such astheir ratio) can serve as a feature for data analysis.

Example 5—Tests on Anisotropic Substrates—Benchtop Impedance Network

We built an anisotropic impedance network with discrete resistors andcapacitors, connected as a topological torus to eliminate boundaryeffects as is outlined above. Multiport impedances of this network weresimulated in Simulation Program with Integrated Circuit Emphasis (SPICE)and compared with measurements using our system (the EIM1001, anembodiment of the disclosure designed and built according to FIGS. 1, 2,3, 9, 10, 11, 12, 40, 41, 48 and 57) and a commercially availablebioimpedance system (the ImpediMed SFB7). These tests were used to: 1)determine accuracy of the EIM1001 system; 2) compare sensitivity of theorthogonal configuration against the inline configuration; and 3)compare the EIM1001 with a commercial bioimpedance system (SFB7).

Accuracy and Performance:

FIG. 50 illustrates measurements using our system EIM1001 and the SFB7on a known impedance network and compares them with a SPICE simulation.The frequency range of the EIM1001 is 1 kHz-10 MHz, while SFB7 range isonly 3 kHz-1 MHz. Both systems showed excellent agreement at lowerfrequencies when compared with the SPICE simulation. However, between400 kHz and 1 MHz, the SFB7 shows significant measurement error whilethe EIM1001 maintains high fidelity. Even beyond 1 MHz, EIM1001 showedexcellent agreement with simulations. Such improvements are veryimportant given the prospect of important diagnostic information beingprovided by these higher frequency ranges. Multiple impedance networkconfigurations were tested, and the EIM1001 consistently showedsignificantly better performance than the SFB7. Further, impedanceamplitude and phase errors for the EIM1001 were always below 2% and 1°up to 1 MHz. Above 1 MHz, errors were below 4% and 2°.

Sensitivity:

Our experiments showing high fidelity between EIM1001 benchtop tests andSPICE simulations allowed us to confidently perform complex experimentsin simulation. To compare sensitivity of orthogonal and inlinemeasurements to changes in impedance values, the network used in FIG. 50was simulated using different resistor values. We found that under someconditions orthogonal measurements were more sensitive to changes thanclassical in-line measurements. For example, changing one set ofresistors by a factor of 2× resulted in a 51.7% change in orthogonalmeasurements, but only 38.5% in inline measurements. This indicatesorthogonal measurements may be more sensitive to changes in musclestructure under some conditions and will likely yield clinicallyvaluable information.

Example 6—Tests on Anisotropic Substrates—Biological Substrate

A series of meat experiments were conducted to determine: 1) angularresolution needed to quantify anisotropy; 2) frequency resolution neededto accurately characterize the impedance frequency response; 3)potential value of EIM data above 1 MHz; 4) effect of isotropic layerson measurements; and 5) effect of electrode force on measurements.

Angular Resolution:

FIGS. 51 and 52 show measurements of fresh flank steak using bothorthogonal and inline tetrapolar electrode geometries. Measurements weremade at 50 kHz over angular range 0°-180° with resolution of 9°. Theregularity of these results suggests a functional form for themeasurement using parameterized fit. For example, for generalanisotropic surfaces, including meat, a sinusoidal parameterization α|sin[2(θ−φ)]|+β fits very well for orthogonal measurements, withparameters α (amplitude), β (offset), and φ (phase shift). Similarly, asine-squared parameterization fits inline well. In the figures, thesefits are shown and have small error. Such parameterizations fortetrapolar measurements over angle are novel and have not been reportedpreviously. They have a design consequence: only three samples from eachof these curves are needed to fit each parameterization, and additionalangular measurements simply improve fit via least-squares optimization.

Frequency Resolution:

FIGS. 53-55 show several measurements on meat taken from approximately 1kHz to approximately 10 MHz with 10 points/decade. The impedance spectrahave no sharp resonances, meaning that frequency response does notchange drastically over a small interval. As a result, we can use theNyquist criterion to minimize the number of frequency sampling pointsrequired to recover the entire frequency response, with accuracy limitedonly by noise and signal size. Even simple linear interpolation yieldsaccurate estimates of the meat's impedance response using only 3points/decade (FIG. 53). Other embodiments can involve sampling 10frequencies per decade at the expense of longer measurement time andreducing the number of frequencies over a given range to decreasemeasurement time and improve usability.

Ability to Detect Changes in Tissue Status:

To evaluate effects of change in muscle condition and size, meat wastenderized and sliced to assess the value of impedance informationacross the frequency spectrum. Although slicing and tenderizing are pooranalogs for muscle atrophy and breakdown, tenderizing affects meatmicro-structure while slicing affects its macro-geometry andneuromuscular diseases impact both micro- and macro-structures ofmuscle. FIG. 12 shows the effect of these manipulations on the meat'simpedance structure. H is a fresh (“healthy”) measurement, S is afterslicing, ST is after then tenderizing, STS is a second slicing, etc.

FIG. 54, shows that tenderizing primarily flattens the spectrum over 1kHz-10 MHz while slicing primarily shifts it. A result is thattenderizing had minimal effect at 10 MHz, and so measurement at 10 MHz(in this experiment) provides size information independent oftenderizing. The difference between 1 kHz and 10 MHz impedance magnitude(the “flatness”) then yields information about tenderizing andanisotropy. This suggests that integration of low and high frequencyinformation can help a practitioner determine how a patient's musclesare improving or degrading with treatment. Currently, no bioimpedanceinstrument measures accurately above 1 MHz while benchtop tests confirmthe EIM1001 accuracy up to 10 MHz.

Impact of Isotropic Layers:

TX151 is a versatile isotropic gelling agent that we used as a phantomfor skin. To understand the effect an isotropic layer like skin wouldhave on measurements of muscle, we compared impedance of TX151 to baremeat and to meat with a thin top layer of TX151 (FIG. 55) which suggestthat measurements through skin can yield meaningful measurements ofmuscle structure. The experiment shows that an isotropic layer canresult in attenuation of orthogonal transfer impedance but there islimited distortion (FIG. 55). This measurement uses the “orthogonal”configuration which results in low transfer impedance values forisotropic material, explaining the small values for the TX151measurement curve.

Electrode Force:

Experiments were conducted to determine the effects of applied electrodeforce on impedance measurements. A fresh piece of meat was tested withvarying amounts of force (0.2-0.8 N) and data were compared. We foundthat impedance amplitude changes were less than 1 over all frequenciesand phase changes were less than 0.2°. The effects were much smallerthan those caused by tenderizing or slicing, and indicate that it shouldbe possible to determine muscle structure with non-constant forceelectrodes as long as the muscle's geometry is not significantlymodified.

Example 7—EIM Device with Improved Capability

The electronic system, summarized in FIG. 56, significantly outperformsexisting state-of-the-art systems, with improved information under 1 MHzand new, never-before researched data over 1 MHz.

Example 8—Graphical User Interface (GUI)

The GUI, an example of which is shown in FIG. 57, guides the operatorthrough the procedure and displays data along the way. The startup pageshown in FIG. 57A requests anonymous data for the patient and siteincluding the patient number, gender, date of birth, etc. It also asksthe operator to certify that certain steps outlined in the protocol havebeen taken prior to starting the exam. This helps ensure the protocol isfollowed carefully.

Example 9—Conformable Electrode Arrays

FIG. 35A shows one design of conformable electrode array. FIG. 35B showsthe another design that we fabricated and tested. There are a number ofembodiments of the disclosure. In one embodiment, a conformable,rubberlike base with hollow middle was designed such that the electrodearray easily conforms to curved surfaces. The electrode arrays were thenprinted on thin PET (2 mils) and wrapped around the rubber base,adhering them using double-sided, pressure-sensitive adhesive (PSA). Theelectrodes were “printed” onto the PET material using a carbonbasedconductive ink overlaid on silver-based conductive ink. This allowssignificantly less expensive manufacturing and greater flexibility withrespect to electrode array design. In another embodiment, a novelconnection mechanism was designed using magnets and pogo pins allowingthe electrode array to easily “snap” onto the handheld device (see FIG.58D). FIG. 35C shows the top and bottom of the assembled conformableelectrode array. On the top side there are landing pads that connect thearray to the handheld unit and metal disks that snap onto the magnets.On the bottom side are the printed electrodes. In another embodiment, anelectrode array with 20 electrodes was designed that allowed both inlineand orthogonal configurations at four different angles (0°, 45°, 90°,and 135°). FIG. 35D shows the electrode array. The electrodes circled inred and yellow represent one possible electrode configuration. Usingmultiplexers, a variety of other electrode configurations can beselected. FIG. 35E-F show how the electrode array conforms to a curvedsurface. Since EIM is usually performed on extremities (arms and legs)that have similar curvatures, this design offers excellent performancein that it ensures good contact between the electrodes and the skin.

In another embodiment, the housing for the device includes aconstant-force actuator that uses a passive mechanical system with aconstant-force mainspring connected to the top of actuator to extend itwith constant force. FIG. 58A shows the full system including thehandheld device and a small netbook computer.

FIG. 58B shows the inside of the handheld unit including the constantforce actuation (CFA) spring. The actuator moves through a linearbearing preventing side motion and providing a low degree of friction(FIG. 58C). A simple plastic ring is included to fit the device anddeactivate the constant-force actuator as needed.

FIG. 58D shows the bottom of the housing which has two magnets and 24pogo pins. The top of an electrode array is also shown. The electrodearray snaps onto the handheld device and is held there by magnets.However, any suitable securing mechanism may be used. Pogo pinselectrically connect the handheld unit to the electrode arrays by makingcontact with landing pads printed on top of the electrode array usingsilver-based conductive ink. This design makes it very quick and easy toreplace the electrode array which will eventually be disposable.

Testing of Constant Force Actuator:

FIG. 59 shows the fully assembled handheld unit and electrode arrayplaced on top of a scale. FIG. 59A shows that the weight of the deviceis 338 grams. FIG. 59B shows the handle when some force is applied, butnot enough to cause the spring to begin to compress. In FIG. 59C, justenough force is applied for the spring to begin to compress. At thatpoint, the handle moves downward and a force equivalent to 1328 grams isshown on the scale. As slightly more force is applied, the handle movesdown some more (FIG. 59D), but approximately the same amount of force isapplied to the scale (1319 grams). As the handle is pressed nearly toits range limit, FIG. 59E shows that the scale shows 1320 grams; almostexactly the same amount of equivalent force. This experiment, along withothers, confirmed that the CFA worked excellently. Across a range ofnearly 3 cm, the variation in applied force was less than 1%.

Example 10—Measurements with Human Subjects

We performed measurements on 5 ALS patients and 7 healthy subjects. Thisallowed us to test for repeatability performance, and also gain data onhow well our device and algorithms could differentiate between healthyand sick subjects.

Protocol:

The proposed protocol (15 repeated measurements on biceps) was performedon all healthy subjects. In addition, we collected data on 5 muscles(biceps, wrist flexors, quadriceps, tibialis anterior, andgastrocnemius) and repeated the full sweep of measurements a secondtime. For the ALS patients, two sets of measurements were also conducted(test-retest). However, the 15 repeated tests on biceps were not carriedout since we found them to be time consuming and did not want to fatiguethe patients. FIGS. 60A and 60B show the device 60030 with a holder60020 supporting the flexible patch 38030 (see FIG. 38) pressed againstthe gastrocnemius and biceps 60010 of a healthy subject showing how wellthe electrode 38040 array (see FIG. 38) conformed to the curvature.

Cole Mode Verification:

Cole models were applied directly to data obtained from healthy and ALSsubjects. The Cole interpolation of a healthy (blue) and ALS (red)subject are shown in FIG. 61. The dotted gray line represents the idealCole output based on the Cole parameters outlined above, and the red andblue points represent the fitted data points. Evidently, the measuredreactance and resistance (and thus, impedance) fits the Cole model withaccuracy for both healthy and ALS subjects. Furthermore, there is asignificant separation and difference in radii between the Coleinterpolations of the healthy and ALS subjects allowing for easydiscrimination between the two.

Repeatability Tests of Healthy Adult Subjects:

7 healthy subjects were recruited for the purpose of testingrepeatability of the constant-force patch electrode and constant-forceactuator. All of the patients signed informed consent forms andunderwent multiple rounds of testing with the constant-force patchelectrode, including rounds with the constant-force actuator enabled andthe constant-force actuator disabled. Furthermore, measurements werealso taken with a strip electrode array configuration in order to allowcomparisons of repeatability between the multi-angle patch electrode anda strip electrode. It was found that the protocol having 15 repeatedmeasurements was very cumbersome and time-consuming for both the nurseand the patient. As a result, near the end of the study, the protocolwas modified to include only 5 repeated measurements. The repeatedmeasurements were taken on the biceps. All subjects were contactedwithin two days of their visit and no subjects complained of any adverseeffects.

Data Analysis:

Repeatability of phase, resistance and reactance at 50-kHz, 100-kHz and150-kHz was analyzed through calculation of the intra-correlationcoefficients.

Furthermore, the repeatability of the anisotropy of these parameters atthe aforementioned frequencies was also calculated. Repeatability of themulti-angle electrode was also measured with and without theconstant-force actuator enabled. Lastly, we looked at the repeatabilityof the multiangle electrodes in comparison with the strip electrodes.The results of these analyses are the following. The intra-classcorrelations for the 0 degrees and anisotropic measurements are shownare shown in Table 1. For all parameters, there was strong to nearlyperfect agreement between the measurements. Furthermore, the degree ofvariation among the best three trials of any set of measurements wasless than 8%. There was a high degree of repeatability in themeasurements with the multi-angle constant-force patch electrode over alarge frequency range (30-kHz to 3-MHz).

TABLE 1 Intra-class correlation coefficients for 0 degrees andanisotropic measurements of phase, resistance and reactance at 50-kHzand 100-kHz. All,parameters showed strong agreement between theintra-class measurements.* ICC- Parameter 1 cc-0° Anisotron  50-kHzPhase 0.8321 0.9024 100-kHz Phase 0.8677 0.8259  50-kHz Resistance 0.9930.8625 100-kHz Resistance 0.994 0.9069  50-kHz Reactance 0.7779 0.8644100-kHz Reactance 0.7138 0.6902

Example 10—Calculating the Semi-Ellipse

Any standard method of quadratic optimization can be used for solvingfor an ellipse that fits the data. The methods listed below are examplesof how to solve for the parameters of the ellipse. In these cases, theellipse is parameterized by the equation:

R ² u ₁ +X ² u ₂ +Ru ₃ +Xu ₄ =u ₅>0

-   -   where R and X are resistance and reactance. Here, we list        several methods of solving for u given measurements for R and X:

Solution method Details of solution method $\quad\begin{matrix}{\quad{\min\limits_{{u}_{2} = 1}{{Mu}}_{2}}} \\{{(M)_{i\; 1} = R_{i}^{2}},{(M)_{i\; 2} = X_{i}^{2}}} \\{{(M)_{i\; 3} = R_{i}},{(M)_{i\; 4} = X_{i}},{(M)_{i\; 5} = 1}}\end{matrix}$ Minimizing u is the minimum singular vector of M.$\quad\begin{matrix}\begin{matrix}\begin{matrix}{\min\limits_{u}{{Mu}}_{2}} \\{{(M)_{i\; 1} = R_{i}^{2}},{(M)_{i\; 2} = X_{i}^{2}}}\end{matrix} \\{{(M)_{i\; 3} = R_{i}},{(M)_{i\; 4} = X_{i}},{(M)_{i\; 5} = 1}}\end{matrix} \\{u_{1} = L}\end{matrix}$ Requires solution of constrained quadratic optimization.First component of u (x-axis/resistance radius) is guaranteed to bepositive for L > 0. Equality can also be made an inequality for sameresult. $\quad\begin{matrix}\begin{matrix}\begin{matrix}{\min\limits_{u}{{Mu}}_{2}} \\{{(M)_{i\; 1} = R_{i}^{2}},{(M)_{i\; 2} = X_{i}^{2}}}\end{matrix} \\{{(M)_{i\; 3} = R_{i}},{(M)_{i\; 4} = X_{i}},{(M)_{i\; 5} = 1}}\end{matrix} \\{{u_{1} = L_{1}},{u_{2} \geq L_{2}}}\end{matrix}$ Same as above but guarantees the second component of u(y-axis/ reactance radius) is also positive if L2 > 0.$\quad\begin{matrix}\begin{matrix}\begin{matrix}{\min\limits_{u}{{Mu}}_{2}} \\{{(M)_{i\; 1} = R_{i}^{2}},{(M)_{i\; 2} = X_{i}^{2}}}\end{matrix} \\{{(M)_{i\; 3} = R_{i}},{(M)_{i\; 4} = X_{i}},{(M)_{i\; 5} = 1}}\end{matrix} \\{{u_{1} = L_{1}},{u_{2} = L_{2}}}\end{matrix}$ Same as above but fixes the aspect ratio of the ellipse(and can be fixed to a circle if L1 = L2). $\quad\begin{matrix}\begin{matrix}\begin{matrix}\begin{matrix}{\min\limits_{u}{{Mu}}_{2}} \\{{(M)_{i\; 1} = R_{i}^{2}},{(M)_{i\; 2} = X_{i}^{2}}}\end{matrix} \\{{(M)_{i\; 3} = R_{i}},{(M)_{i\; 4} = X_{i}},{(M)_{i\; 5} = 1}}\end{matrix} \\{{u_{1} = L_{1}},{{u_{2} \geq {L_{2}\mspace{14mu} {OR}\mspace{14mu} u_{2}}} = L_{2}}}\end{matrix} \\{{u_{3} < 0},{u_{4} > 0}}\end{matrix}$ Same as above but guarantees the center of the ellipsefitting the data has a positive resistance and a negative reactance.

Since the Cole model lies along a circle with a center that has apositive resistance and a negative reactance, the final optimizationwith L₁=L₂>0 and u₂=L₂ is preferable and guarantees the fitting ellipsesatisfies these properties, which the prior optimizations do notguarantee. Although a Cole model does not inherently fit an ellipse, weinclude a description of how to apply an elliptical fit because theaspect ratio of the ellipse provides an additional feature forneuromuscular disease analysis using EIM.

To convert these parameters to Cole parameters, we perform the followingsteps:

-   -   Determine the center (cx,cy) of the ellipse fitting the data,        the x-axis radius r, and the aspect ratio k of the ellipse:

k = u₁/u₂$r = \sqrt{\frac{u_{3}^{2} + {u_{4}^{2}k}}{4u_{1}^{2}} - \frac{u_{5}}{u_{1}}}$${c_{x} = \frac{- u_{3}}{2u_{1}}},{c_{y} = \frac{{- k}\; u_{4}}{2u_{1}}}$

-   -   Solve for the Cole parameters (using an implicit conversion of        the ellipse to a circle):

$R_{0} = {\sqrt{r^{2} - {c_{y}^{2}/k}} + c_{x}}$$R_{\infty} = {c_{x} - \sqrt{r^{2} - {c_{y}^{2}/k}}}$${\alpha = {\frac{2}{\pi}\cos^{- 1}\frac{1 - \gamma^{2}}{1 + \gamma^{2\;}}}},{\gamma = {\frac{r - {c_{y}/\sqrt{k}}}{\sqrt{r^{2} - {c_{y}^{2}/k}}}a}}$

Finally, with three of the four Cole parameters solved, we solve for theremaining parameter by solving a one-dimensional optimization. As such,a direct search for an optimal solution is feasible, and, further,experiments seem to indicate that the optimizations are quasi-convexoptimization (simply meaning that there is only a single locally-optimalsolution to the optimization):

Optimization Description$\min\limits_{\tau}{\sum\limits_{i}{{{Z_{\tau}\left( \omega_{i} \right)} - R_{i} - {jX}_{i}}}^{2}}$Finds the parameters that minimize the normed error of the raw dataversus the fitted data. $\quad\begin{matrix}\begin{matrix}{\theta_{i} = {a\; \tan \; 2\left( {R_{i} - c_{x} + {jX}_{i} - {jc}_{y}} \right)}} \\{{\varphi_{i}(\tau)} = {a\; \tan \; 2\left( {{Z_{\tau}\left( \omega_{i} \right)} - c_{x} - {jc}_{y}} \right)}}\end{matrix} \\{\min\limits_{\tau}{\sum\limits_{i}{{\theta_{i} - {\varphi_{i}(\tau)}}}^{2}}}\end{matrix}$ With respect to the center of the circle fitting the data,each data point has angle (between −π and π). This minimizes the errorin the angle of the actual data and the fitted data. This can also bemodified so that the error in the angles does not suffer numericinaccuracies due to the crossing thresholds at −π and π.

Experiments have shown that the second optimization seems to yield moreconsistent solutions than the first.

FIG. 61 shows a plot of a Cole model fitting data. In this case, thenegative reactance is plotted, which is consistent with neuromuscularEIM data.

Listed in U.S. Pat. No. 9,113,808, which is incorporated herein in itsentirety by reference, is the Matlab code for an example of thecalculations we performed.

The following terms will be used in the following examples and in theclaims: “base plate”—a plastic plate which becomes part of thedisposable sensor. Flex circuit—a thin, flexible laminar structure whichcontains circuitry and becomes part of the disposable sensor. “foamsubstrate” or “foam block”—one or more sections of compressiblepolymeric foam which become part of the disposable sensor. “salinepouch”—a pouch made of plastic film or multilayer film containing salinesolution. “gel block”—a block of gel which contains solution andreleases it during system use. “disposable sensor”—a sensor forproviding contact to the subject. It includes the base plate, the flexcircuit and can contain the foam block, the saline pouch, the gel blockand other components. “absorbent fluid reservoir”—a reservoir whichholds saline fluid and applies it to the disposable sensor before use bythe subject. “device”—rigid or semirigid part which is held by the userduring use, contains electronics and connections, and is attached to thedisposable sensor. “composite assembly”—the device plus the disposablesensor.

Example 11—Plastic Injection Molded Base Plate

A plastic injection molded base plate (1004 in FIG. 64) is used in thedisposable sensor to provide a platform for assembly of the disposableitself, as well as a method for attachment to the handheld device. Thisinjection molding provides all mounting features and is intended to be alow cost component in a high volume disposable, material volume istherefore kept to a minimum. This base plate is designed to maximizefeature and structural integrity while reducing material volume andcost. While not intending to be limiting, the materials of choice forthe base plate would include polycarbonate, ABS or polystyrene. Thematerials can be filled or reinforced. Other materials which might beused include nylon and moldable polyester. There may be an integratedclip which is designed to be functional without breaking as it shouldnever reach its yield stress point during intended use conditions. (1012in FIG. 65) The disposable sensor is affixed to the handheld measurementdevice via means of either the built in plastic clip that is part of thedisposable, or alternatively/additionally via a magnetic clasp (magnetsin the handheld device work with steel elements embedded into thedisposable.) The disposable is ‘keyed’ to ensure it can only be affixedto the handheld in one correct orientation.

The overall perimeter size is 4 inches×3 inches with ⅛ inch nominal wallthickness. Recessed pockets are included in the design to allow theaddition of ferrous and/or magnetized disks to enable or facilitate themagnetic catch feature. A recess at each electrical pin is included toallow the “petals” of the flex circuit to have a space to move. Avertical wall is incorporated to act as a registration guide forassembly of the flex circuit. Two or more circular registration bosseswith appropriate lead-in chamfer edges are also included. These bossesmate with holes in the flex circuit to enhance alignment duringassembly. Further, a recess is included to allow a single use digitalchip to be included.

Example 12—Flex Circuit

The construction of the disposable sensor is shown in FIGS. 64-69. Theflex circuit is shown in FIG. 64, item 1002. It has a laminarconstruction using a carrier film. Without intending to be limiting,preferred films are polyester and polyimide although biaxially orientedpolypropylene and other films might be used. Most preferred is 2 milbiaxially oriented PET film. In one embodiment, the contacts are printedon one side of the first film and the circuit on the other side of thefilm. Without intending to be limiting, preferred inks are silver and/orcarbon ink although other conductive inks might be used. A small tab maybe included on the flex circuit to provide a location to include anencodable chip for verification, single time use tracking and otherpurposes. A film with pressure sensitive adhesive on both sides islaminated onto the printed circuit side of the first film A protectivelayer remains bonded onto the other side of the pressure sensitive filmuntil further processing.

Example 13—Foam Substrate

The foam substrate assembly (1008 in FIG. 64) has a number of differenttypes of foam. Without intending to be limiting, one way to manufacturethe foam sub assembly is from die cut elements. The foam type anddurometer hardness can be varied depending upon the particularapplication of the sensor or body part being tested. In general, twotypes of foam are used, open cell and closed cell foams are used eitherto create a fluid barrier or fluid store. The foam substrate can have arecess or cutaway (1010 in FIG. 64) to permit insertion and retention ofthe saline pouch or gel block. Without intending to be limiting, thepreferred foam is polyurethane, however, cellulose, EPDM, latex or otherfoams can be used.

Example 14—Saline Pouch

The saline pouch is manufactured from biaxially oriented polypropylenefilm. Without intending to be limiting, polyethylene film or polyesterfilm can be used for the saline pouch. A multilayer film with or withoutan adhesive layer can be used for the saline pouch. The saline pouch isformed by joining the pieces of film by methods known in the artincluding heat sealing, ultrasonic sealing, vibration sealing oradhesive sealing. Preferred methods are heat sealing and ultrasonicsealing. The pouch is filled with an aqueous saline solution and sealed.The pouch can be manufactured in a manual process, semi-automatedprocess or on a form-fill and seal machine.

Saline release is accomplished in one of 2 ways, A) The pouch ispunctured via needle like features designed into the plastic base plate,and protected by a removable shield prior to use. Removal of the shieldallows the spikes to puncture the pouch, or B) a ‘tear off strip’ isused whereby an orifice or series of orifices in the pouch are coveredduring manufacture with a plastic film strip. This strip has a tab whichthe user pulls to remove the tab, hence opening the pouch and allowingthe saline to be ready to move from the pouch to the foam reservoir.

The saline solution is a 0.7 N solution of sodium chloride in water.Without intending to be limiting, a concentration range of 0.01N to 5.0N can be used and other salts like potassium chloride or mixtures ofsalts can be used. The pouch is intended to have a flat pillow like formthat is then inserted into the foam substrate during assembly.

Example 15—Gel Block

Rather than the saline pouch, and in place or addition to the foamsubstrate, the disposable sensor can contain a gel block. This would bemade from solid gel. By solid gel, we mean a gel material which issufficiently crosslinked that when swollen with fluid retains a threedimensional shape and, while deformable and compressible, upon removalof any external force, returns to its original shape. The gel block ispreferably a single unit or, alternately, a small number of units. Gelpaste or small gel beads are not intended in our definition of gelblock.

The gel block is manufactured from conductive ionic gel material ornonionic gel. Without intending to be limiting, partially or totallyneutralized crosslinked polyacrylic acid, hydroxypropyl cellulose,hydroxypropylmethyl cellulose and hydroxypropyl starch may be preferredmaterials. Other solid gel materials could include polymethacrylic acidand other ionic polymers. Copolymers of these monomers are alsocontemplated. The gel solid can be swollen with water or with salinesolution or with other ionic solution. The ionic gel can be manufacturedusing a method similar to that outlined in U.S. Pat. Nos. 5,221,722,4,783,510 and 5,856,410, all of which are incorporated herein in theirentirety by reference except that the crosslinker level is adjusted tomeet the needs of the application and the reactive mixture is placed ina mold or other method to give a solid block rather than a dispersion.

Example 16—the Flex Circuit/Block Combination without Pouch

Without intending to be limiting, one design for the disposable sensorwould have foam block or gel block from Examples 13 and 15 placedagainst the injection molded base plate from Example 11. The backingfrom the pressure sensitive adhesive layer of the flexible circuit ofExample 12 may be removed and the flexible circuit wrapped around thefoam block/molded base with the exposed pressure sensitive adhesive tothe inside. The printed contacts which are applied to the patient are onthe foam block side and the oval contacts are on the injection moldedblock side. An exploded view is shown in FIG. 69.

Example 17—the Flex Circuit/Block Combination with Pouch

This design for the disposable sensor—flex circuit/block combinationwith pouch—is assembled in a manner similar to Example 16 except thatthe pouch of Example 13 or gel matrix of Example 15 is inserted into arecess in the foam block prior to assembly. Holes have been punched inthe flex circuit during its manufacture or subsequent to its manufactureto allow release of the conductive fluid. An exploded view is shown inFIG. 68.

Example 18—Absorbent Fluid Reservoir

The absorbent fluid is a tray or dish which contains an absorbent blockor blocks. The absorbent block or blocks are infused with salinesolution. In use, the assembled device is placed on the absorbent fluidreservoir after a measurement on a patient. This holds the device in asafe, non-contaminating way and also coats the sensor face with anappropriate quantity of saline solution. The device is then removed fromthe absorbent fluid reservoir, used to make another measurement on apatient and then returned to the absorbent fluid reservoir. Since, overtime, the absorbent fluid reservoir can lose fluid and not providesufficient saline for a measurement, the device and electronic circuitrycan have capability to measure electronically the moisture level of theabsorbent fluid reservoir and communicate (as with a green light orother signal) that the wetting is sufficient.

Example 19—Packaging the Absorbent Fluid Reservoir and the DisposableSensor

The absorbent fluid reservoir can come packaged with the disposablesensor inserted. The two items can be packaged in a moisture barrierpouch. The user would then open the pouch, attach the device to thedisposable sensor remove the assembled device from the absorbent fluidreservoir for the first application to the patient. To avoid lack ofsterility, cross-contamination, etc. it can be desirable to verify thatthe absorbent fluid reservoir is not being reused but is a single use,disposable item. This could be effected by a molded piece which isbroken off and gives an authorizing signal to the chip in the flexcircuit, inclusion of an RFID chip in the absorbent fluid reservoirwhich would send a single use authorization to the device upon firstuse, or other method.

Example 20—Using the Composite Assembly Example 20A with Neither FluidPouch or Absorbent Fluid Reservoir

The complete assembly (device plus disposable sensor) is connected tothe electronics. The subject is wiped with saline solution on thedesired place of contact. The disposable sensor is placed on the subjectand measurements made. The disposable sensor is then removed from thesubject. The composite assembly is shown in FIG. 70. The disposablesensor is on the bottom in the figure.

Example 20B with Fluid Pouch

Once the disposable sensor is removed from its packaging it is affixedto the handheld measurement device via means of either the built inplastic clip that is part of the disposable, oralternatively/additionally via a magnetic clasp (magnets in the handhelddevice work with steel elements embedded into the disposable sensor.)The disposable sensor is ‘keyed’ to ensure it can only be affixed to thehandheld in one correct orientation.

With the disposable sensor affixed to the handheld device to form thecomposite assembly, the practitioner is now ready to begin the testingprocedure. In order to activate the disposable sensor and release theincluded saline, the practitioner would be required to perform an actionto open the included saline pouch. It is envisaged that there are anumber of ways to achieve this as mentioned in the previous section.

(A) Puncture the pouch: The practitioner would ‘arm’ the disposablesensor by either removing a guard that shields the puncture needle(s),or would push an element on the disposable sensor or the device toexpose the needles. Once ‘armed’ the user would then ‘pump’ thedisposable sensor (mounted on the handheld) against the tissue that isto be tested. This pumping action is a compression that forces thedisposable against the tissue, which in turn puts pressure on the foamand hence the saline reservoir pouch. Saline then flows from the pouchinto the open cell ‘sponge’ foam and charges the disposable sensor.Small holes in the sensor surface allow saline to transfer from the foamthrough the holes onto the sensor surface and hence onto the patientsskin. The action of pumping is then augmented with motion to spread thesaline over the sensor and skin. Once sufficient saline is present onthe skin, the sensor makes electrical contact and the system indicatesthe status of the signal via indicator lights on the device as well asin the software on the computer screen.

(B) Pull tab release: In the same manner as (A) the practitioner willarm the disposable sensor, however in this embodiment the arming will bedone via the removal of a ‘pull tab’ (similar to those used onelectronic devices to enable a battery to be connected). Removal of thepull tab exposes holes in the saline pouch membrane. The user thenproceeds to ‘pump’ the device just like in option (A) to charge the foamreservoir.

Both option A & B are envisaged to have either a single saline pouch, ora segmented/multi pouch included. The goal of this inclusion is toprovide a series of releases of saline to enable fine control over theamount of saline being released. When one reservoir has been exhausted,the next can be opened and so on.

Upon completion of the procedure, or use of that particular sensor(multiple sensors may be required) the disposable is simply removed anddisposed of along with its packaging.

Example 20C with Absorbent Fluid Reservoir

The base plate of Example 11 and the Flex Circuit of Example 12 areassembled as in Example 16 to form the disposable sensor.

A foam substrate is used between the plastic base plate and the flexcircuit sensor in order to facilitate a flexible and pliable assemblythat when applied to the subject's anatomy can readily deform to providea consistent contact between the sensor circuit and the subject's skin.This foam is injection molded from an open cell foam that will act as asponge to create the fluid storage. Injection molding of the foam causesthe outside surfaces to form a skin that is watertight.

Saline is not incorporated directly into the ‘disposable’ in thisconcept, instead a separate saline reservoir is supplied in the form ofa device stand that includes a foam ‘stamp pad’ that is pre-wetted withsaline.

The ‘Stand’ shown below is comprised of 2 parts, the stand itself ismanufactured from a thermoformed plastic sheet in order to create astable base for the registration and temporary storage of the completeassembly of the device and disposable. Contained within the stand thereis the ‘stamp pad reservoir’, this is a simple die cut foam pad that isheld into the stand via adhesive on the bottom of the foam. The adhesivecould be double sided PSA or another adhesive that will allow the pad tobond to the stand.

Once the pad is installed into the stand, during assembly the pad isthen pre-wetted with saline, the amount of saline is adjusted based onthe desired life of the saline dispensing, factoring in the amount ofsaline transferred from the pad to the sensor, as well as evaporation.

The completed stand then is assembled with a sensor, and the entireassembly is bagged in a sealed pouch that does not permit anyevaporation.

Example 21 Foam—the Composite Assembly

The electronic sensor portion of the disposable is applied to the baseplate via means of registration features in both elements. The flexcircuit is bonded to the base plate using pressure sensitive adhesive(PSA) that is a component of the laminate of the ‘flex circuit sensor’.Assembly is done at the time of sensor manufacture, not by thepractitioner. The flex circuit incorporates a ‘petal’ style ofelectrical connector that allows the sensor to form an electricalconnection with the handheld device through a set of fixed pins in thehandheld device. The ‘petals’ in the sensor allow for misalignment andtolerance stack-up between the device and the disposable to ensure aviable electrical connection.

A foam substrate is used between the plastic base plate and the flexcircuit sensor in order to facilitate a flexible and pliable assemblythat when applied to the patients anatomy can readily deform to providea consistent contact between the sensor circuit and the patients skin.

Example 22—Foam—Prewetted and Skinned Foam Block

This foam is injection molded from an open cell foam that will act as asponge to create the fluid storage. Injection molding of the foam causesthe outside surfaces to form a skin that is watertight. The molded blockis then hot wire or saw cut to create the curved surface that backs upthe flex circuit sensor. When cut the open cell foam is exposed on thatface.

A blotter layer is then laid onto the cut face of the foam. This blotterlayer is intended to absorb the saline solution and create anintermediate layer between the foam block and the flex sensor, thepurpose of which is to evenly distribute the saline and limit flow tothe sensor from the foam reservoir. The layer is made from a suitablematerial such as cotton or similar synthetic alternative.

The Saline solution is infused into the foam block during assembly. Onceassembly is complete the entire disposable sensor is packaged in a waterand air tight package to ensure no evaporation of the solution duringstorage and shipping.

Saline travels from the foam, through the blotter layer and on to theflex sensor surface via a series of small holes punched into the flexsensor. The position of these holes is optimized to ensure saline isdelivered to the appropriate areas to enable the best electricalproperties to complete a test.

Optionally larger holes can be made in the sensor and foam transferstrips/pads can be included to store more saline at the sensor surface.

Example 23—Use Model for the Prewetted and Skinned Foam Block

This design would be supplied as a complete assembly in a sterile singleuse package, which would be assigned to the patient for one procedureand would be opened immediately prior to or during the setup for theprocedure.

Once the disposable is removed from its packaging it would be affixed tothe handheld measurement device via means of either the built in plasticclip that is part of the disposable, or alternatively/additionally via amagnetic clasp (magnets in the handheld device work with steel elementsembedded into the disposable.) The disposable is ‘keyed’ to ensure itcan only be affixed to the handheld in one correct orientation.

With the disposable affixed to the handheld the practitioner is nowready to begin the testing procedure. In order to activate thedisposable device i.e. release the included saline, the practitioner issimply required to press the disposable against the patients tissuesufficiently to compress the foam block. The act of compressing thisblock forces saline out of the reservoir and into the blotter, and on tothe sensor surface. At this time the practitioner would move thedisposable sensor across the patients skin to spread the saline until asufficiently good signal is achieved and indicated by the LED indicatorsin the handheld device.

Upon completion of the procedure, or use of that particular sensor(multiple sensors may be required) the disposable is simply removed anddisposed of along with its packaging.

Example 24—Foam Pre Wetted and Bagged

Identical to Example 22, however instead of using a skinned foam, thefoam block would be cut from a block of open cell foam, assembled to theblotter and then inserted into a preformed plastic bag (likely PET, PVCbut any film polymer would work. The bag is then sealed around the foamvia PSA adhesive already on the bag, or via ultrasonic/RF welding.

The sop surface of the bag that sits above the blotter would be prepunched with holes to allow saline to egress the bag and flood thesensor flex circuit.

Example 25 Foam—Pre Wetted and Vacuum Formed Container

Identical to Example 22, however instead of using a skinned foam, thefoam block would be cut from a block of open cell foam, assembled to theblotter and then inserted into a vacuum formed carrier (withoutintending to be limiting, likely PET, PVC, PE, PP but any thermoformable film polymer would work). The carrier is then sealed around thefoam via PSA adhesive already on the carrier, or via ultrasonic/RFwelding or other method of joining.

The top surface of the bag that sits below the flex circuit would be prepunched with holes to allow saline to egress the bag and flood thesensor flex circuit.

Example 26—Use Model for the Absorbent Fluid Reservoir

This design would be supplied as a complete assembly in a sterile singleuse package, which would be assigned to the patient for one procedureand would be opened immediately prior to or during the setup for theprocedure.

Once the disposable and flexible absorbent reservoir (stand/stamp pad)are removed from packaging, the stand is placed on a convenient worksurface. The disposable sensor is affixed to the handheld measurementdevice via means of either the built in plastic clip that is part of thedisposable, or alternatively/additionally via a magnetic clasp (magnetsin the handheld device work with steel elements embedded into thedisposable.) The sensor is ‘keyed’ to ensure it can only be affixed tothe handheld in one correct orientation.

With the disposable sensor affixed to the handheld the practitioner isnow ready to begin the testing procedure. In order to prepare thecomposite assembly for use, saline must be applied to the sensor byplacing the device in the stand and pressing down. The action ofpressing down causes saline to be transferred from the pad to thesensor.

It is envisaged that surface coatings may be employed on the sensor topromote adhesion of saline to the sensor pads, and not to the substrate.The appropriate hydrophilic and hydrophobic coatings can be used toaffect the surface tension and wettability of the sensor.

Additionally electronic status indicators can be used in the compositeassembly and/or in the system to signal the user when sufficient salineis present on the sensor while ‘docked’ in the stand.

Upon completion of the procedure, or use of that particular sensor(multiple sensors may be required) the disposable is simply removed anddisposed of along with its packaging.

Example 27—Surface Strips/Pads Wipe

The base plate of Example 11 and the Flex Circuit of Example 12 areassembled as in Example 16.

A foam substrate is used between the plastic base plate and the flexcircuit sensor in order to facilitate a flexible and pliable assemblythat when applied to the patients anatomy can readily deform to providea consistent contact between the sensor circuit and the patients skin.This foam is injection molded from an open cell foam that will act as asponge to create the fluid storage. Injection molding of the foam causesthe outside surfaces to form a skin that is watertight.

Saline is not incorporated directly into the ‘disposable’ foam block,instead a strip or pad or multiples of are included on the sensorsurface. These pads contain saline much like a saline wipe. The actionof rubbing the disposable on the patients skin transfers saline form thepads to the skin.

The completed stand then is assembled with a sensor, and the entireassembly is bagged in a sealed pouch that does not permit anyevaporation.

Example 28—Use Model for the Surface Strips/Pads Wipe

This design would be supplied as a complete product in a sterile singleuse package, which would be assigned to the patient for one procedureand would be opened immediately prior to or during the setup for theprocedure.

Once the disposable is removed from its packaging, the disposable sensoris affixed to the handheld measurement device via means of either thebuilt in plastic clip that is part of the disposable, oralternatively/additionally via a magnetic clasp (magnets in the handhelddevice work with steel elements embedded into the disposable.) Thedisposable is ‘keyed’ to ensure it can only be affixed to the handheldin one correct orientation.

With the disposable affixed to the handheld the practitioner is nowready to begin the testing procedure. In order to prepare the disposabledevice for use, saline must be applied to the sensor by placing thedevice on the patients skin and moving it across the surface to transfersaline from the pads to the skin.

Upon completion of the procedure, or use of that particular sensor(multiple sensors may be required) the disposable is simply removed anddisposed of along with its packaging.

We claim:
 1. A method for measuring a localized biological transferimpedance (LBTI) of skeletal muscle tissue, using a device including asensor with a plurality of electrodes, the plurality of electrodesincluding at least a pair of current electrodes and a pair of voltageelectrodes, with one or more of the plurality of electrodes comprisingone or more sensor pads, the method comprising: positioning theplurality of electrodes of the device in contact with a portion of thetissue so that at least one sensor pad is in contact with the portion ofskeletal muscle tissue; passing a current through the skeletal muscletissue using the pair of current electrodes so that the current alsopasses through the at least one sensor pad which is in contact with theportion of tissue; measuring a signal across the pair of voltageelectrodes, the signal corresponding to a voltage resulting from thecurrent passed through the skeletal muscle tissue; analyzing the currentpassed through the skeletal muscle tissue and the measured voltagesignal to determine the localized biological transfer impedance (LBTI)of the skeletal muscle tissue using LBTI to address at least onecondition selected from the group consisting of cardiac output,neuromuscular disease, back pain, neck pain, and muscular health and inwhich LBTI does not comprise whole body measurements